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
StateLicense IDTaxonomies
IN28183517A363L00000X
OH363LF0000X363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1518100353Medicaid