Healthcare Provider Details

I. General information

NPI: 1689723785
Provider Name (Legal Business Name): LYLE C BURKLE MS APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 06/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4101 WOOLWORTH AVE BLDG 8
OMAHA NE
68105-1850
US

IV. Provider business mailing address

5025 RAVEN OAKS DR
OMAHA NE
68152-1744
US

V. Phone/Fax

Practice location:
  • Phone: 402-995-5795
  • Fax:
Mailing address:
  • Phone: 402-995-5795
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number33966
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number114009
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: