Provider Demographics
NPI:1548314537
Name:BURNHAM, JOHANNA EILEEN (RN)
Entity type:Individual
Prefix:
First Name:JOHANNA
Middle Name:EILEEN
Last Name:BURNHAM
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 RING ST
Mailing Address - Street 2:
Mailing Address - City:RENSSELAER
Mailing Address - State:NY
Mailing Address - Zip Code:12144-2528
Mailing Address - Country:US
Mailing Address - Phone:518-427-6778
Mailing Address - Fax:
Practice Address - Street 1:325 COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:NY
Practice Address - Zip Code:12534-1905
Practice Address - Country:US
Practice Address - Phone:518-828-9446
Practice Address - Fax:518-828-9450
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY317636-1163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse