Provider Demographics
NPI:1003849522
Name:BURTNER, MICHELE L (CNM)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:L
Last Name:BURTNER
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:905 CULVER RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14609-7115
Mailing Address - Country:US
Mailing Address - Phone:585-275-7892
Mailing Address - Fax:
Practice Address - Street 1:905 CULVER RD
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14609-7115
Practice Address - Country:US
Practice Address - Phone:585-275-7892
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-08
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1278367A00000X
NYF001278-1367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9642885Medicaid
WA9642885Medicaid
Q28970Medicare UPIN