Provider Demographics
NPI:1497961478
Name:BURKHART, JANICE M
Entity Type:Individual
Prefix:MRS
First Name:JANICE
Middle Name:M
Last Name:BURKHART
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 1:48544 CENTERVILLE JACOBSBURG ROAD
Mailing Address - Street 2:
Mailing Address - City:JACOBSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43933-8762
Mailing Address - Country:US
Mailing Address - Phone:740-686-2090
Mailing Address - Fax:
Practice Address - Street 1:51670 WEGEE ROAD
Practice Address - Street 2:
Practice Address - City:BELLAIRE
Practice Address - State:OH
Practice Address - Zip Code:43906-9629
Practice Address - Country:US
Practice Address - Phone:740-686-2747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2132454Medicaid