Provider Demographics
NPI:1245477819
Name:BURCH, JANE R (PA-C)
Entity type:Individual
Prefix:MS
First Name:JANE
Middle Name:R
Last Name:BURCH
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:529 BURWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48103-3933
Mailing Address - Country:US
Mailing Address - Phone:734-665-5790
Mailing Address - Fax:
Practice Address - Street 1:3511 BEMIS RD
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-9307
Practice Address - Country:US
Practice Address - Phone:734-434-2691
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-19
Last Update Date:2009-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601002982363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant