Provider Demographics
NPI:1063704484
Name:BURNS, TANESSA DANIELLE (RN)
Entity type:Individual
Prefix:
First Name:TANESSA
Middle Name:DANIELLE
Last Name:BURNS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1770 FAIRVIEW RD
Mailing Address - Street 2:
Mailing Address - City:BIDWELL
Mailing Address - State:OH
Mailing Address - Zip Code:45614-9130
Mailing Address - Country:US
Mailing Address - Phone:740-645-3153
Mailing Address - Fax:
Practice Address - Street 1:1770 FAIRVIEW RD
Practice Address - Street 2:
Practice Address - City:BIDWELL
Practice Address - State:OH
Practice Address - Zip Code:45614-9130
Practice Address - Country:US
Practice Address - Phone:740-645-3153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-03
Last Update Date:2014-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH358276163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse