Provider Demographics
NPI:1417735002
Name:BURESS, JAMIE SHERE
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:SHERE
Last Name:BURESS
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 1:1717 MEADOWLARK AVE
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43614-3941
Mailing Address - Country:US
Mailing Address - Phone:567-312-3808
Mailing Address - Fax:
Practice Address - Street 1:1717 MEADOWLARK AVE
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43614-3941
Practice Address - Country:US
Practice Address - Phone:567-312-3808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-15
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
No171W00000XOther Service ProvidersContractor