Healthcare Provider Details

I. General information

NPI: 1528067568
Provider Name (Legal Business Name): MARY ELIZABETH BURKETT CFNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2005
Last Update Date: 01/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1360 N SAINT HELEN RD
SAINT HELEN MI
48656-9521
US

IV. Provider business mailing address

1360 N SAINT HELEN RD P O BOX 39
SAINT HELEN MI
48656-9521
US

V. Phone/Fax

Practice location:
  • Phone: 989-389-4944
  • Fax: 989-389-1401
Mailing address:
  • Phone: 989-389-4944
  • Fax: 989-389-1401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number4704110149
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: