Provider Demographics
NPI:1831689355
Name:BURTON, VANESSA DENISE
Entity type:Individual
Prefix:MS
First Name:VANESSA
Middle Name:DENISE
Last Name:BURTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4201 N MULFORD RD
Mailing Address - Street 2:
Mailing Address - City:LOVES PARK
Mailing Address - State:IL
Mailing Address - Zip Code:61111-6953
Mailing Address - Country:US
Mailing Address - Phone:815-797-9367
Mailing Address - Fax:
Practice Address - Street 1:4201 N MULFORD RD
Practice Address - Street 2:
Practice Address - City:LOVES PARK
Practice Address - State:IL
Practice Address - Zip Code:61111-6953
Practice Address - Country:US
Practice Address - Phone:815-797-9367
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-10
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist