Provider Demographics
NPI:1396099750
Name:BURCKHARTTE, LORI K (LPN)
Entity type:Individual
Prefix:MRS
First Name:LORI
Middle Name:K
Last Name:BURCKHARTTE
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 GLADDING AVE
Mailing Address - Street 2:
Mailing Address - City:ASHTABULA
Mailing Address - State:OH
Mailing Address - Zip Code:44004-2413
Mailing Address - Country:US
Mailing Address - Phone:440-969-0972
Mailing Address - Fax:
Practice Address - Street 1:1505 GLADDING AVE
Practice Address - Street 2:
Practice Address - City:ASHTABULA
Practice Address - State:OH
Practice Address - Zip Code:44004-2413
Practice Address - Country:US
Practice Address - Phone:440-969-0972
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-06
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH137699164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse