Provider Demographics
NPI:1477977759
Name:BURNS, JARIE (LPN)
Entity Type:Individual
Prefix:MS
First Name:JARIE
Middle Name:
Last Name:BURNS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5321 ROCKPORT AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45417-8337
Mailing Address - Country:US
Mailing Address - Phone:937-718-4363
Mailing Address - Fax:
Practice Address - Street 1:5321 ROCKPORT AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45417-8337
Practice Address - Country:US
Practice Address - Phone:937-718-4363
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-07
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH136656164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse