Provider Demographics
NPI:1770378879
Name:BURGE, HEATHER ELISHA
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:ELISHA
Last Name:BURGE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:756 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-6930
Mailing Address - Country:US
Mailing Address - Phone:740-334-9949
Mailing Address - Fax:
Practice Address - Street 1:756 E MAIN ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-6930
Practice Address - Country:US
Practice Address - Phone:740-334-9949
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-10
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care