Basic Information
| Provider Information | |||||||||
| NPI: | 1033487061 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BURKHARDT | ||||||||
| FirstName: | MARY | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 205 JEFFERSON AVE | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452171708 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5136414375 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4750 WESLEY AVE | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452122244 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5135315110 | ||||||||
| FaxNumber: | 5135311327 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/05/2011 | ||||||||
| LastUpdateDate: | 12/05/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WG0600X | RN251979 | OH | Y | Nursing Service Providers | Registered Nurse | Gerontology |
No ID Information.