Provider Demographics
NPI:1578357448
Name:BURDETTE, ALEXIS (STNA)
Entity type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
Last Name:BURDETTE
Suffix:
Gender:
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10088 STATE ROUTE 800 SE
Mailing Address - Street 2:
Mailing Address - City:UHRICHSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44683-7467
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6184 EAST EXTENSION AVENUE SE
Practice Address - Street 2:
Practice Address - City:GNADENHUTTEN
Practice Address - State:OH
Practice Address - Zip Code:44629
Practice Address - Country:US
Practice Address - Phone:330-340-6929
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-07
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH7930758Medicaid