Provider Demographics
NPI:1922200880
Name:BURNETT, COURTNEY ERIN
Entity Type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:ERIN
Last Name:BURNETT
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 1:9632 LOVELESS RD
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43044-9535
Mailing Address - Country:US
Mailing Address - Phone:937-834-3190
Mailing Address - Fax:
Practice Address - Street 1:9632 LOVELESS RD
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:OH
Practice Address - Zip Code:43044-9535
Practice Address - Country:US
Practice Address - Phone:937-834-3190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor