Provider Demographics
NPI:1295040939
Name:BURTON, AMBER JANELLE
Entity Type:Individual
Prefix:MS
First Name:AMBER
Middle Name:JANELLE
Last Name:BURTON
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 1:2538 WHEATON RD
Mailing Address - Street 2:
Mailing Address - City:BIDWELL
Mailing Address - State:OH
Mailing Address - Zip Code:45614-9348
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2538 WHEATON RD
Practice Address - Street 2:
Practice Address - City:BIDWELL
Practice Address - State:OH
Practice Address - Zip Code:45614-9348
Practice Address - Country:US
Practice Address - Phone:740-416-5604
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-17
Last Update Date:2010-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH104764877799Medicaid