Individual
DANA MARIE BURGESS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
3095 KETTERING BLVD, MORAINE, OH 45439-1983
(937) 293-8300
Mailing address
972 GARVER RD, MIDDLETOWN, OH 45044-8929
(513) 594-7664
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LPN.161652.MEDS-IV
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
164W00000X
—
OH
Enumeration date
05/15/2019
Last updated
05/15/2019
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