Provider Demographics
NPI:1538423553
Name:BURG, MARY KAY (LPN)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:KAY
Last Name:BURG
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 1:11751 VALLEY VIEW AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45246-2223
Mailing Address - Country:US
Mailing Address - Phone:513-885-0287
Mailing Address - Fax:
Practice Address - Street 1:11751 VALLEY VIEW AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45246-2223
Practice Address - Country:US
Practice Address - Phone:513-885-0287
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-25
Last Update Date:2012-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN043945-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse