Provider Demographics
NPI:1649493354
Name:BURKHART, CHRISTINE JANE (LPN)
Entity type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:JANE
Last Name:BURKHART
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 1:1720 MEADOWS RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:OH
Mailing Address - Zip Code:44057-1834
Mailing Address - Country:US
Mailing Address - Phone:440-645-8564
Mailing Address - Fax:
Practice Address - Street 1:1720 MEADOWS RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:OH
Practice Address - Zip Code:44057-1834
Practice Address - Country:US
Practice Address - Phone:440-645-8564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH105276164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2279636Medicaid