Provider Demographics
NPI:1598383473
Name:BURRAGE, ANNA T
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:T
Last Name:BURRAGE
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 1:9202 SOLON DR
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-4618
Mailing Address - Country:US
Mailing Address - Phone:513-200-9769
Mailing Address - Fax:513-954-5838
Practice Address - Street 1:9202 SOLON DR
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-4618
Practice Address - Country:US
Practice Address - Phone:513-954-8583
Practice Address - Fax:513-954-5838
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-08
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCHW-000214172V00000X
OH175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No172V00000XOther Service ProvidersCommunity Health Worker