Healthcare Provider Details

I. General information

NPI: 1316717028
Provider Name (Legal Business Name): GLENDA SUE BURKE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/03/2024
Last Update Date: 01/03/2024
Certification Date: 01/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1575 DELUCCHI LN STE 114
RENO NV
89502-6581
US

IV. Provider business mailing address

6400 SHARLANDS AVE APT M1083
RENO NV
89523-2739
US

V. Phone/Fax

Practice location:
  • Phone: 775-432-1223
  • Fax:
Mailing address:
  • Phone: 775-240-2962
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN23877
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: