Provider Demographics
NPI:1063458446
Name:BURLES, JO ANN (CRNA)
Entity Type:Individual
Prefix:MS
First Name:JO ANN
Middle Name:
Last Name:BURLES
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:MS
Other - First Name:JO ANN
Other - Middle Name:
Other - Last Name:COLLINS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRNA
Mailing Address - Street 1:3103 CALYDON CT
Mailing Address - Street 2:
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20744-1409
Mailing Address - Country:US
Mailing Address - Phone:301-248-7078
Mailing Address - Fax:301-248-7078
Practice Address - Street 1:3103 CALYDON CT
Practice Address - Street 2:
Practice Address - City:FORT WASHINGTON
Practice Address - State:MD
Practice Address - Zip Code:20744-1409
Practice Address - Country:US
Practice Address - Phone:301-248-7078
Practice Address - Fax:301-248-7078
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR114245174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist