Provider Demographics
NPI: | 1518100353 |
---|---|
Name: | BURCH, VICKIE S (APN) |
Entity Type: | Individual |
Prefix: | |
First Name: | VICKIE |
Middle Name: | S |
Last Name: | BURCH |
Suffix: | |
Gender: | F |
Credentials: | APN |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 840 NW WASHINGTON BLVD STE C |
Mailing Address - Street 2: | |
Mailing Address - City: | HAMILTON |
Mailing Address - State: | OH |
Mailing Address - Zip Code: | 45013-6381 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 513-737-7246 |
Mailing Address - Fax: | 513-737-6601 |
Practice Address - Street 1: | 840 NW WASHINGTON BLVD STE C |
Practice Address - Street 2: | |
Practice Address - City: | HAMILTON |
Practice Address - State: | OH |
Practice Address - Zip Code: | 45013-6381 |
Practice Address - Country: | US |
Practice Address - Phone: | 513-737-7246 |
Practice Address - Fax: | 513-737-6601 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2009-04-09 |
Last Update Date: | 2024-02-01 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
IN | 28183517A | 363L00000X |
OH | 363LF0000X | 363LF0000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
OH | 1518100353 | Medicaid |