Provider Demographics
NPI:1093366536
Name:BURRAGE, DOTIANNA
Entity Type:Individual
Prefix:
First Name:DOTIANNA
Middle Name:
Last Name:BURRAGE
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 1:432 W WISE RD
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60193-4063
Mailing Address - Country:US
Mailing Address - Phone:773-996-9244
Mailing Address - Fax:
Practice Address - Street 1:675 S ROSELLE RD
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60193-3100
Practice Address - Country:US
Practice Address - Phone:847-352-5500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-25
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
No251J00000XAgenciesNursing Care