Provider Demographics
NPI:1588927834
Name:BURNETTE, EMILY ELLEN (DO)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:ELLEN
Last Name:BURNETTE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1319 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-4005
Mailing Address - Country:US
Mailing Address - Phone:740-687-2229
Mailing Address - Fax:740-785-9549
Practice Address - Street 1:1319 E MAIN ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-4005
Practice Address - Country:US
Practice Address - Phone:740-687-2229
Practice Address - Fax:740-785-9549
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-21
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
OH34.012129207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program