Individual
JACQUELINE MARIE BURKS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
668 PAGE ST APT 4, RAVENNA, OH 44266-2870
(133) 028-1820
Mailing address
668 PAGE ST APT 4, RAVENNA, OH 44266-2870
(133) 028-1820
Taxonomy
Speciality
Code
Description
License number
State
374U00000X
Home Health Aide
Primary
6705177
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0176244
—
OH
Enumeration date
01/02/2024
Last updated
01/02/2024
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