Provider Demographics
NPI:1386468304
Name:BURCH, JENEE CANDICE
Entity type:Individual
Prefix:
First Name:JENEE
Middle Name:CANDICE
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 1:7328 N HAMMOND CIR
Mailing Address - Street 2:
Mailing Address - City:WARR ACRES
Mailing Address - State:OK
Mailing Address - Zip Code:73132-5711
Mailing Address - Country:US
Mailing Address - Phone:580-704-6394
Mailing Address - Fax:
Practice Address - Street 1:2423 NW 40TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-8716
Practice Address - Country:US
Practice Address - Phone:405-419-8873
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-15
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist