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General NPI Number Information
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NPI Number | 1841012812
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Entity Type | Individual
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Provider Name | JACQUETTE BURNEY
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Gender | Female
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Dates
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Enumeration Date | 10/30/2024
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Last Update Date | 10/30/2024
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Provider Practice Location Address
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Address Line | 21350 CAROL DR
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City | EUCLID
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State | OH
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Zip | 44119-1831
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Country | US
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Telephone | 330-338-3588
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Fax |
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Provider Business Mailing Address
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Address Line | 21350 CAROL DR
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City | EUCLID
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State | OH
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Zip | 44119-1831
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Country | US
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Telephone | 330-338-3588
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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 | 171WV0202X
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Taxonomy Name | Vehicle Modifications Contractor
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License Number | SY974147
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License Number State | OH
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