1568578136 NPI number — JOELLEN BURTON RN

Table of content: JOELLEN BURTON RN (NPI 1568578136)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568578136 NPI number — JOELLEN BURTON RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BURTON
Provider First Name:
JOELLEN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LOEHMER
Provider Other First Name:
JOELLEN
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1568578136
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1015 MICHIGAN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOGANSPORT
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46947-1526
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
574-722-5151
Provider Business Mailing Address Fax Number:
574-722-9523

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
408 NORTH ST
Provider Second Line Business Practice Location Address:
BRIDGES ENTERPRISE
Provider Business Practice Location Address City Name:
LOGANSPORT
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46947-2895
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
574-753-5540
Provider Business Practice Location Address Fax Number:
574-753-8197
Provider Enumeration Date:
08/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  28137743A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 28137743A . This is a "RN LICENSE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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