Provider Demographics
NPI:1861619777
Name:BURCHIEL, SHARON KAYE
Entity type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:KAYE
Last Name:BURCHIEL
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 1:10035 CR 135
Mailing Address - Street 2:
Mailing Address - City:KENTON
Mailing Address - State:OH
Mailing Address - Zip Code:43326-9134
Mailing Address - Country:US
Mailing Address - Phone:419-673-8340
Mailing Address - Fax:
Practice Address - Street 1:520 DAKOTA RD
Practice Address - Street 2:
Practice Address - City:BELLEFONTAINE
Practice Address - State:OH
Practice Address - Zip Code:43311-2347
Practice Address - Country:US
Practice Address - Phone:937-592-0885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN050287164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2100354Medicaid