Provider Demographics
NPI:1730788159
Name:BURTON, RANDA MARIE
Entity type:Individual
Prefix:
First Name:RANDA
Middle Name:MARIE
Last Name:BURTON
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 1:80 US ROUTE 40 E APT 18
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45338-8092
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:80 US RT 40 EAST
Practice Address - Street 2:APT 18
Practice Address - City:LEWISBURG
Practice Address - State:OH
Practice Address - Zip Code:45338
Practice Address - Country:US
Practice Address - Phone:937-733-2234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-19
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide