MEDICARE: LISA BURKE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	R 202973-3	MN

General Provider Information

NPI Number	:	1497173256
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA BURKE

Provider Business Mailing Address
First Line	:	4301 AMBER DR
Second Line	:
City	:	EAGAN
State	:	MN
Zip	:	55122-2038
Country	:	US
Telephone Number	:	612-703-4343
Fax Number	:

Provider Business Practice Location Address
First Line	:	4301 AMBER DR
Second Line	:
City	:	EAGAN
State	:	MN
Zip	:	55122-2038
Country	:	US
Telephone Number	:	612-703-4343
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/30/2014
Last Update Date	:	03/30/2014

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Directions to “ LISA BURKE ” Practice Location

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