Provider Demographics
NPI:1588420517
Name:BURHAM, CHUTIMA S (AANP)
Entity type:Individual
Prefix:
First Name:CHUTIMA
Middle Name:S
Last Name:BURHAM
Suffix:
Gender:F
Credentials:AANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5474 ROUTE 474
Mailing Address - Street 2:
Mailing Address - City:ASHVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14710-9555
Mailing Address - Country:US
Mailing Address - Phone:818-915-3388
Mailing Address - Fax:
Practice Address - Street 1:15 S MAIN ST
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-6626
Practice Address - Country:US
Practice Address - Phone:716-664-7725
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-27
Last Update Date:2024-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF311694-01363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health