Healthcare Provider Details

I. General information

NPI: 1124563614
Provider Name (Legal Business Name): ALEXANDREA BURNETT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALEXANDREA BACHANI

II. Dates (important events)

Enumeration Date: 12/20/2016
Last Update Date: 12/29/2022
Certification Date: 12/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8865 W 400 N SUITE 155
MICHIGAN CITY IN
46360-3096
US

IV. Provider business mailing address

PO BOX 781076
DETROIT MI
48278-1076
US

V. Phone/Fax

Practice location:
  • Phone: 219-872-6566
  • Fax: 219-872-2712
Mailing address:
  • Phone: 317-528-4800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number28150028A
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71006835A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: