Provider Demographics
NPI:1861281057
Name:BURNSIDE, NATAZJA ZAKHIA LATRICE
Entity type:Individual
Prefix:
First Name:NATAZJA
Middle Name:ZAKHIA LATRICE
Last Name:BURNSIDE
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 1:1022 BYRD AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45215-2223
Mailing Address - Country:US
Mailing Address - Phone:513-619-0536
Mailing Address - Fax:
Practice Address - Street 1:1022 BYRD AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45215-2223
Practice Address - Country:US
Practice Address - Phone:513-619-0536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-05
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator