Provider Demographics
NPI:1235889767
Name:BURKE, AMANDA LEANN FREY
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:LEANN FREY
Last Name:BURKE
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 1:72 OAKWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:MC DERMOTT
Mailing Address - State:OH
Mailing Address - Zip Code:45652-8996
Mailing Address - Country:US
Mailing Address - Phone:740-464-4249
Mailing Address - Fax:
Practice Address - Street 1:72 OAKWOOD AVE
Practice Address - Street 2:
Practice Address - City:MC DERMOTT
Practice Address - State:OH
Practice Address - Zip Code:45652-8996
Practice Address - Country:US
Practice Address - Phone:740-464-4249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-27
Last Update Date:2022-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care