MEDICARE: VALERIE BURDETTE

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	314000000X	Skilled Nursing Facility	32000991A	IN

General Provider Information

NPI Number	:	1770030504
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VALERIE BURDETTE

Provider Business Mailing Address
First Line	:	1872 E COUNTY ROAD 825 S
Second Line	:
City	:	OAKLAND CITY
State	:	IN
Zip	:	47660-8911
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1872 E COUNTY ROAD 825 S
Second Line	:
City	:	OAKLAND CITY
State	:	IN
Zip	:	47660-8911
Country	:	US
Telephone Number	:	812-582-2384
Fax Number	:

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

Provider Enumeration Date	:	09/09/2016
Last Update Date	:	09/09/2016

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Directions to “ VALERIE BURDETTE ” Practice Location

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