Individual
BROCK BURRIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
1711 DOVER AVE, DOVER, OH 44622-2529
(330) 987-6707
Mailing address
1711 DOVER AVE, DOVER, OH 44622-2529
(330) 987-6707
Taxonomy
Speciality
Code
Description
License number
State
163WE0003X
Emergency Registered Nurse
Primary
48411
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
408411
RN LISCENCE
OH
Enumeration date
07/23/2017
Last updated
07/21/2022
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