MEDICARE: TINA BURLEIGH RN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3747A0650X	Attendant Care Provider	RN.408134	OH
2	163W00000X	Registered Nurse	RN.408134	OH

General Provider Information

NPI Number	:	1205231289
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TINA BURLEIGH RN

Provider Business Mailing Address
First Line	:	4224 CLINES CHAPEL RD
Second Line	:
City	:	WAVERLY
State	:	OH
Zip	:	45690-9117
Country	:	US
Telephone Number	:	740-835-8668
Fax Number	:	740-835-8668

Provider Business Practice Location Address
First Line	:	4224 CLINES CHAPEL RD
Second Line	:
City	:	WAVERLY
State	:	OH
Zip	:	45690-9117
Country	:	US
Telephone Number	:	740-835-8668
Fax Number	:	740-835-8668

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/03/2014
Last Update Date	:	03/02/2022

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