Provider Demographics
NPI:1134807951
Name:BURNS, BROOKLYN
Entity type:Individual
Prefix:
First Name:BROOKLYN
Middle Name:
Last Name:BURNS
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 1:893 SANDALWOOD RD E
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-3220
Mailing Address - Country:US
Mailing Address - Phone:419-279-4730
Mailing Address - Fax:
Practice Address - Street 1:893 SANDALWOOD RD E
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-3220
Practice Address - Country:US
Practice Address - Phone:419-279-4730
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-11
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker