Provider Demographics
NPI:1093317653
Name:BURDEN, ZENAIDE MARIE
Entity Type:Individual
Prefix:
First Name:ZENAIDE
Middle Name:MARIE
Last Name:BURDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:149 S WEBB ST # 149
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-6223
Mailing Address - Country:US
Mailing Address - Phone:174-033-4807
Mailing Address - Fax:
Practice Address - Street 1:149 S WEBB ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-6223
Practice Address - Country:US
Practice Address - Phone:740-334-8072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-09
Last Update Date:2020-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2843490Medicaid