Provider Demographics
NPI:1356828222
Name:BURCH, SUSAN M (LPN)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:BURCH
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 1:37 DIETZ ST
Mailing Address - Street 2:
Mailing Address - City:ONEONTA
Mailing Address - State:NY
Mailing Address - Zip Code:13820-1882
Mailing Address - Country:US
Mailing Address - Phone:607-432-2250
Mailing Address - Fax:607-723-4087
Practice Address - Street 1:37 DIETZ ST
Practice Address - Street 2:
Practice Address - City:ONEONTA
Practice Address - State:NY
Practice Address - Zip Code:13820-1882
Practice Address - Country:US
Practice Address - Phone:607-432-2250
Practice Address - Fax:607-723-4087
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-24
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY332159164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse