Provider Demographics
NPI:1194104042
Name:BURTCHETT, HEIDI LYBB
Entity type:Individual
Prefix:MRS
First Name:HEIDI
Middle Name:LYBB
Last Name:BURTCHETT
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 1:2947 TWELVE OAKS DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:MI
Mailing Address - Zip Code:48813-8364
Mailing Address - Country:US
Mailing Address - Phone:517-449-0801
Mailing Address - Fax:
Practice Address - Street 1:2947 TWELVE OAKS DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:MI
Practice Address - Zip Code:48813-8364
Practice Address - Country:US
Practice Address - Phone:517-449-0801
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-26
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other