Provider Demographics
NPI:1558009969
Name:BURCHEL, JAKOB DILLON (DNP, CRNA)
Entity Type:Individual
Prefix:MR
First Name:JAKOB
Middle Name:DILLON
Last Name:BURCHEL
Suffix:
Gender:M
Credentials:DNP, CRNA
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:250 N SHADELAND AVE
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-4959
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2900 16TH ST
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:IN
Practice Address - Zip Code:47421-3510
Practice Address - Country:US
Practice Address - Phone:812-276-4378
Practice Address - Fax:812-275-1246
Is Sole Proprietor?:No
Enumeration Date:2022-05-25
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY3017820367500000X
IN28273644A367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100820520Medicaid
IN300064779Medicaid
IN940070016OtherMEDICARE