Provider Demographics
NPI:1477689420
Name:BURNHEIMER, SUSAN ELAINE
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:ELAINE
Last Name:BURNHEIMER
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 1:13450 HARMON RD
Mailing Address - Street 2:
Mailing Address - City:PICKERINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43147-8429
Mailing Address - Country:US
Mailing Address - Phone:614-861-6592
Mailing Address - Fax:
Practice Address - Street 1:210 E MILL ST
Practice Address - Street 2:
Practice Address - City:CIRCLEVILLE
Practice Address - State:OH
Practice Address - Zip Code:43113-1916
Practice Address - Country:US
Practice Address - Phone:740-474-8577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2300549Medicaid