Provider Demographics
NPI:1902179476
Name:BURCH, JANINA MARIA (LPN)
Entity Type:Individual
Prefix:
First Name:JANINA
Middle Name:MARIA
Last Name:BURCH
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1384 BRISTOW ST APT 5A
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10459-1342
Mailing Address - Country:US
Mailing Address - Phone:347-778-6483
Mailing Address - Fax:
Practice Address - Street 1:1384 BRISTOW ST APT 5A
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10459-1342
Practice Address - Country:US
Practice Address - Phone:347-778-6483
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-14
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY306257164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse