Healthcare Provider Details

I. General information

NPI: 1295394807
Provider Name (Legal Business Name): KATRINE MARIE BURKE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2019
Last Update Date: 06/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3301 CANDELARIA RD NE STE B
ALBUQUERQUE NM
87107-1965
US

IV. Provider business mailing address

3301 CANDELARIA RD NE STE B
ALBUQUERQUE NM
87107-1965
US

V. Phone/Fax

Practice location:
  • Phone: 505-273-6300
  • Fax: 505-265-7860
Mailing address:
  • Phone: 505-273-6300
  • Fax: 505-265-7860

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: