MEDICARE: JODI BURHENN

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	246ZE0600X	Electroneurodiagnostic Specialist/Technologist		IN

General Provider Information

NPI Number	:	1235516881
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JODI BURHENN

Provider Business Mailing Address
First Line	:	4081 W STATE ROAD 234
Second Line	:
City	:	MCCORDSVILLE
State	:	IN
Zip	:	46055-9318
Country	:	US
Telephone Number	:	317-601-3294
Fax Number	:

Provider Business Practice Location Address
First Line	:	4081 W STATE ROAD 234
Second Line	:
City	:	MCCORDSVILLE
State	:	IN
Zip	:	46055-9318
Country	:	US
Telephone Number	:	317-601-3294
Fax Number	:

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

Provider Enumeration Date	:	05/04/2015
Last Update Date	:	05/04/2015

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Directions to “ JODI BURHENN ” Practice Location

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