MEDICARE: JOYCE BURNETT LPN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	164W00000X	Licensed Practical Nurse	143972	OH
2	374U00000X	Home Health Aide

General Provider Information

NPI Number	:	1083162374
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOYCE BURNETT LPN

Provider Business Mailing Address
First Line	:	17021 HARVARD AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44128-2211
Country	:	US
Telephone Number	:	216-278-5955
Fax Number	:	216-400-7165

Provider Business Practice Location Address
First Line	:	17021 HARVARD AVE
Second Line	:
City	:	CLEVELAND
State	:	OH
Zip	:	44128-2211
Country	:	US
Telephone Number	:	216-278-5955
Fax Number	:	216-400-7165

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/14/2016
Last Update Date	:	03/30/2017

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