Provider Demographics
NPI:1861567471
Name:BURCHUM, JACQUELINE ROSENJACK (DNSC, APRN, BC)
Entity type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:ROSENJACK
Last Name:BURCHUM
Suffix:
Gender:F
Credentials:DNSC, APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 SAND PIT LOOP
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:TN
Mailing Address - Zip Code:38320-6426
Mailing Address - Country:US
Mailing Address - Phone:731-584-3567
Mailing Address - Fax:
Practice Address - Street 1:410 SAND PIT LOOP
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:TN
Practice Address - Zip Code:38320-6426
Practice Address - Country:US
Practice Address - Phone:731-584-3567
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000005674363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily