Healthcare Provider Details

I. General information

NPI: 1467344986
Provider Name (Legal Business Name): DONNA (JEANNIE) JEAN BURNIE AGCNS-BC
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/18/2025
Last Update Date: 07/18/2025
Certification Date: 07/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10500 MONTGOMERY RD
MONTGOMERY OH
45242-4402
US

IV. Provider business mailing address

10500 MONTGOMERY RD
MONTGOMERY OH
45242-4402
US

V. Phone/Fax

Practice location:
  • Phone: 513-865-1496
  • Fax:
Mailing address:
  • Phone: 513-865-1496
  • Fax: 513-865-1745

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License NumberRN202846
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code364SE0003X
TaxonomyEmergency Clinical Nurse Specialist
License NumberRN202846
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: