Healthcare Provider Details

I. General information

NPI: 1487314316
Provider Name (Legal Business Name): LAUREN BURKE CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2021
Last Update Date: 01/27/2023
Certification Date: 01/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1465 S GRAND BLVD
SAINT LOUIS MO
63104-1003
US

IV. Provider business mailing address

511 ASHLAND AVE
WARRENTON MO
63383-1065
US

V. Phone/Fax

Practice location:
  • Phone: 314-268-4150
  • Fax: 314-268-4019
Mailing address:
  • Phone: 636-456-0543
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number2021021447
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: