Provider Demographics
NPI:1992450548
Name:BURKETT, AILEEN
Entity type:Individual
Prefix:
First Name:AILEEN
Middle Name:
Last Name:BURKETT
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 1:33 S MONROE AVE APT 5
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43205-1099
Mailing Address - Country:US
Mailing Address - Phone:191-880-5695
Mailing Address - Fax:
Practice Address - Street 1:33 S MONROE AVE APT 5
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43205-1099
Practice Address - Country:US
Practice Address - Phone:918-805-6757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-12
Last Update Date:2022-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program