Provider Demographics
NPI:1194041657
Name:BUROKER, RANDY SCOTT (LPN)
Entity Type:Individual
Prefix:MR
First Name:RANDY
Middle Name:SCOTT
Last Name:BUROKER
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2750 FAIRVIEW CT
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:OH
Mailing Address - Zip Code:45373-8900
Mailing Address - Country:US
Mailing Address - Phone:937-339-8000
Mailing Address - Fax:
Practice Address - Street 1:2750 FAIRVIEW CT
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:OH
Practice Address - Zip Code:45373-8900
Practice Address - Country:US
Practice Address - Phone:937-339-8000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-08
Last Update Date:2010-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH138872164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse