Provider Demographics
NPI:1184934598
Name:BURTON, CASSEMA TYEASE (LPN)
Entity type:Individual
Prefix:
First Name:CASSEMA
Middle Name:TYEASE
Last Name:BURTON
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 1:4480 GRANADA BLVD APT 15
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44128-6014
Mailing Address - Country:US
Mailing Address - Phone:216-772-7679
Mailing Address - Fax:216-772-7679
Practice Address - Street 1:4480 GRANADA BLVD APT 15
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44128-6014
Practice Address - Country:US
Practice Address - Phone:216-772-7679
Practice Address - Fax:216-772-7679
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-19
Last Update Date:2010-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN128384-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse