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General NPI Number Information
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NPI Number | 1396484374
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Entity Type | Individual
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Provider Name | JEREMY MICHAEL BURSLEY FNP-C
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Gender | Male
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Dates
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Enumeration Date | 05/31/2022
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Last Update Date | 10/24/2022
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Provider Practice Location Address
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Address Line | 3600 KOLBE RD STE 11
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City | LORAIN
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State | OH
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Zip | 44053-1652
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Country | US
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Telephone | 440-222-4003
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Fax |
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Provider Business Mailing Address
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Address Line | 3600 KOLBE RD STE 11
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City | LORAIN
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State | OH
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Zip | 44053-1652
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Country | US
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Telephone | 440-222-4003
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LC1500X
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Taxonomy Name | Community Health Nurse Practitioner
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License Number | F04220271
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN.CNP.0031266
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License Number State | OH
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