Provider Demographics
NPI:1265299952
Name:BURTON, TRESSA NICOLE (STNA)
Entity type:Individual
Prefix:
First Name:TRESSA
Middle Name:NICOLE
Last Name:BURTON
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:998 MAYCLIFFE PL
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45230-3671
Mailing Address - Country:US
Mailing Address - Phone:513-557-9549
Mailing Address - Fax:513-813-3183
Practice Address - Street 1:998 MAYCLIFFE PL
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45230-3671
Practice Address - Country:US
Practice Address - Phone:513-557-9549
Practice Address - Fax:513-813-3183
Is Sole Proprietor?:No
Enumeration Date:2024-02-29
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH377570470700374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0099332Medicaid