Healthcare Provider Details

I. General information

NPI: 1699975508
Provider Name (Legal Business Name): LORI BETH BURKE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2007
Last Update Date: 01/26/2023
Certification Date: 01/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4420 E MCDOWELL RD
PHOENIX AZ
85008-4504
US

IV. Provider business mailing address

102 WOODMONT BLVD STE 600
NASHVILLE TN
37205-5250
US

V. Phone/Fax

Practice location:
  • Phone: 602-858-4295
  • Fax: 602-858-4297
Mailing address:
  • Phone: 615-314-5257
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP2723
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: