Healthcare Provider Details

I. General information

NPI: 1417735002
Provider Name (Legal Business Name): JAMIE SHERE BURESS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2023
Last Update Date: 09/15/2023
Certification Date: 09/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 MEADOWLARK AVE
TOLEDO OH
43614-3941
US

IV. Provider business mailing address

1717 MEADOWLARK AVE
TOLEDO OH
43614-3941
US

V. Phone/Fax

Practice location:
  • Phone: 567-312-3808
  • Fax:
Mailing address:
  • Phone: 567-312-3808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: