Provider Demographics
NPI:1417393471
Name:BURNS, ZIPPORAH LACHELL
Entity Type:Individual
Prefix:MS
First Name:ZIPPORAH
Middle Name:LACHELL
Last Name:BURNS
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:ZIPPORAH
Other - Middle Name:LACHELL
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNA
Mailing Address - Street 1:PO BOX 3107
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65808-3107
Mailing Address - Country:US
Mailing Address - Phone:417-987-1661
Mailing Address - Fax:417-831-0889
Practice Address - Street 1:1643 E COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65803-3909
Practice Address - Country:US
Practice Address - Phone:417-987-1661
Practice Address - Fax:417-831-0889
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-17
Last Update Date:2013-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOCNA 464171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor