Healthcare Provider Details

I. General information

NPI: 1548292204
Provider Name (Legal Business Name): LISA BURKE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 04/21/2022
Certification Date: 04/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8800 WALTHER BLVD
BALTIMORE MD
21234-9001
US

IV. Provider business mailing address

5730 EXECUTIVE DR STE 230
CATONSVILLE MD
21228-1762
US

V. Phone/Fax

Practice location:
  • Phone: 410-882-3240
  • Fax: 410-661-5093
Mailing address:
  • Phone: 410-402-2379
  • Fax: 410-402-2379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License NumberR102686
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: