Provider Demographics
NPI:1104435700
Name:BURCH, ALISHA
Entity type:Individual
Prefix:
First Name:ALISHA
Middle Name:
Last Name:BURCH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7708 RASPBERRY LN
Mailing Address - Street 2:
Mailing Address - City:COATESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46121-9031
Mailing Address - Country:US
Mailing Address - Phone:317-937-9776
Mailing Address - Fax:
Practice Address - Street 1:7708 RASPBERRY LN
Practice Address - Street 2:
Practice Address - City:COATESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46121-9031
Practice Address - Country:US
Practice Address - Phone:317-937-9776
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-29
Last Update Date:2021-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program