Healthcare Provider Details

I. General information

NPI: 1487837647
Provider Name (Legal Business Name): MRS. OLIVE C BURKE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2007
Last Update Date: 12/11/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2025 N 3RD ST SUITE 170
PHOENIX AZ
85004-1471
US

IV. Provider business mailing address

2025 N 3RD ST SUITE 170
PHOENIX AZ
85004-1471
US

V. Phone/Fax

Practice location:
  • Phone: 602-462-1132
  • Fax:
Mailing address:
  • Phone: 602-462-1132
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN079261
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: