Provider Demographics
NPI:1255596334
Name:BURNETT, ANDREA DANEEN (LPN)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:DANEEN
Last Name:BURNETT
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 1:18211 LA SALLE AVE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44119-2001
Mailing Address - Country:US
Mailing Address - Phone:216-527-7667
Mailing Address - Fax:
Practice Address - Street 1:18211 LA SALLE AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44119-2001
Practice Address - Country:US
Practice Address - Phone:216-527-7667
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-28
Last Update Date:2008-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH130264164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse