Provider Demographics
NPI:1083809503
Name:BURTON, RITA MARIE (LPN)
Entity Type:Individual
Prefix:MRS
First Name:RITA
Middle Name:MARIE
Last Name:BURTON
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 ADRIAN CIR
Mailing Address - Street 2:
Mailing Address - City:CONSTANTIA
Mailing Address - State:NY
Mailing Address - Zip Code:13044-2608
Mailing Address - Country:US
Mailing Address - Phone:315-623-7160
Mailing Address - Fax:
Practice Address - Street 1:98 PARADISE RD
Practice Address - Street 2:
Practice Address - City:CENTRAL SQUARE
Practice Address - State:NY
Practice Address - Zip Code:13036
Practice Address - Country:US
Practice Address - Phone:315-668-2253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-07
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY269575164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02680000Medicaid