Healthcare Provider Details

I. General information

NPI: 1255856894
Provider Name (Legal Business Name): HEATHER ANN BURKE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2017
Last Update Date: 10/20/2022
Certification Date: 10/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 W HARRISON ST STE 1010
CHICAGO IL
60612-3845
US

IV. Provider business mailing address

5522 N BERNARD ST
CHICAGO IL
60625-4616
US

V. Phone/Fax

Practice location:
  • Phone: 312-942-5904
  • Fax:
Mailing address:
  • Phone: 773-331-5552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number209.014477
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: