Provider Demographics
NPI:1053119420
Name:BURROWS, NICOLE KAY
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:KAY
Last Name:BURROWS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14603 COUNTY ROAD J
Mailing Address - Street 2:
Mailing Address - City:WAUSEON
Mailing Address - State:OH
Mailing Address - Zip Code:43567-9142
Mailing Address - Country:US
Mailing Address - Phone:419-572-1215
Mailing Address - Fax:
Practice Address - Street 1:14603 COUNTY ROAD J
Practice Address - Street 2:
Practice Address - City:WAUSEON
Practice Address - State:OH
Practice Address - Zip Code:43567-9142
Practice Address - Country:US
Practice Address - Phone:419-572-1215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-03
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3747A0650X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider