Healthcare Provider Details

I. General information

NPI: 1093644007
Provider Name (Legal Business Name): HANNAH ROSE BURKIETT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3105 VILLAGE OFFICE PL
CHAMPAIGN IL
61822-7673
US

IV. Provider business mailing address

3105 VILLAGE OFFICE PL
CHAMPAIGN IL
61822-7673
US

V. Phone/Fax

Practice location:
  • Phone: 217-352-9108
  • Fax:
Mailing address:
  • Phone: 217-352-9108
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number227.024559
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: