Healthcare Provider Details

I. General information

NPI: 1588406060
Provider Name (Legal Business Name): DANTE BURKETT CHW
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2024
Last Update Date: 06/06/2024
Certification Date: 06/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1185 ARTHUR ST
EUGENE OR
97402-3507
US

IV. Provider business mailing address

2996 HARRIS ST
EUGENE OR
97405-4152
US

V. Phone/Fax

Practice location:
  • Phone: 541-944-1578
  • Fax:
Mailing address:
  • Phone: 541-944-1578
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License NumberTHW000111287
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: