Healthcare Provider Details

I. General information

NPI: 1740836725
Provider Name (Legal Business Name): REBECCA ANNE BURKETT LM, CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2019
Last Update Date: 12/16/2019
Certification Date: 12/16/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

616 N PINE ST APT 1
LANSING MI
48933-8002
US

IV. Provider business mailing address

616 N PINE ST APT 1
LANSING MI
48933-8002
US

V. Phone/Fax

Practice location:
  • Phone: 616-719-7361
  • Fax:
Mailing address:
  • Phone: 616-719-7361
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code176B00000X
TaxonomyMidwife
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number7601000053
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: