Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | 44924 | MN |
Y | 207ND0900X | Dermatopathologist | 40176 | KY |
NPI | 1063482214 |
---|---|
Provider Name | Andrea S Burch |
First Address | Prospect, KY 40059-7585 |
Second Address | Prospect, KY 40059-7585 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2006 |
Last Update Date | 27/08/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H65785 | (02) |