Provider Demographics
NPI:1285219030
Name:BURT, ANAYZHIA
Entity Type:Individual
Prefix:
First Name:ANAYZHIA
Middle Name:
Last Name:BURT
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 1:1372 LINWOOD AVE SW APT B
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44710-2349
Mailing Address - Country:US
Mailing Address - Phone:330-327-9285
Mailing Address - Fax:
Practice Address - Street 1:1372 LINWOOD AVE SW APT B
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44710-2349
Practice Address - Country:US
Practice Address - Phone:330-327-9285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-12
Last Update Date:2021-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide