Provider Demographics
NPI:1619571619
Name:BURTON, JERI J
Entity Type:Individual
Prefix:
First Name:JERI
Middle Name:J
Last Name:BURTON
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 1:4066 WALNUT CROSSING DR
Mailing Address - Street 2:
Mailing Address - City:GROVEPORT
Mailing Address - State:OH
Mailing Address - Zip Code:43125-9043
Mailing Address - Country:US
Mailing Address - Phone:614-744-5401
Mailing Address - Fax:
Practice Address - Street 1:4066 WALNUT CROSSING DR
Practice Address - Street 2:
Practice Address - City:GROVEPORT
Practice Address - State:OH
Practice Address - Zip Code:43125-9043
Practice Address - Country:US
Practice Address - Phone:614-744-5401
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide