Provider Demographics
NPI:1083162374
Name:BURNETT, JOYCE (LPN)
Entity Type:Individual
Prefix:
First Name:JOYCE
Middle Name:
Last Name:BURNETT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:JOYCE
Other - Middle Name:
Other - Last Name:BURNETT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPN
Mailing Address - Street 1:17021 HARVARD AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44128-2211
Mailing Address - Country:US
Mailing Address - Phone:216-278-5955
Mailing Address - Fax:216-400-7165
Practice Address - Street 1:17021 HARVARD AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44128-2211
Practice Address - Country:US
Practice Address - Phone:216-278-5955
Practice Address - Fax:216-400-7165
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-14
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH143972164W00000X
374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
No374U00000XNursing Service Related ProvidersHome Health Aide