Healthcare Provider Details

I. General information

NPI: 1457774564
Provider Name (Legal Business Name): NANCY BURKE ACNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/24/2014
Last Update Date: 01/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4440 W 95TH ST
OAK LAWN IL
60453-2600
US

IV. Provider business mailing address

1902 ROSEWOOD CT UNIT 5A
DARIEN IL
60561-4454
US

V. Phone/Fax

Practice location:
  • Phone: 708-684-5360
  • Fax: 708-684-4819
Mailing address:
  • Phone: 630-723-8703
  • Fax: 708-684-4819

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number041.205181
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: