Provider Demographics
NPI:1528641396
Name:BURROWS, CHARLENE ARNITIA (STUDENT)
Entity type:Individual
Prefix:MRS
First Name:CHARLENE
Middle Name:ARNITIA
Last Name:BURROWS
Suffix:
Gender:F
Credentials:STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1125 W VAN BUREN ST APT 1111
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60607-0050
Mailing Address - Country:US
Mailing Address - Phone:405-626-6283
Mailing Address - Fax:
Practice Address - Street 1:11740 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-4732
Practice Address - Country:US
Practice Address - Phone:312-241-3761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-29
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program