Healthcare Provider Details

I. General information

NPI: 1881956712
Provider Name (Legal Business Name): KAREN BUROKER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2012
Last Update Date: 06/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 KALISTE SALOOM RD BLDG 3 STE 100
LAFAYETTE LA
70508-4284
US

IV. Provider business mailing address

8822 EASTWOOD DR
ABBEVILLE LA
70510-4343
US

V. Phone/Fax

Practice location:
  • Phone: 337-262-5311
  • Fax:
Mailing address:
  • Phone: 337-262-5311
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number091939
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: