Healthcare Provider Details

I. General information

NPI: 1215336979
Provider Name (Legal Business Name): PATRICIA ANNE BUERKLE N.P. CLINICAL NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2014
Last Update Date: 08/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CENTER DRIVE SCCF JAIL MEDICAL
RIVERHEAD NY
11971
US

IV. Provider business mailing address

100 CENTER DRIVE SCCF JAIL MEDICAL
RIVERHEAD NY
11971
US

V. Phone/Fax

Practice location:
  • Phone: 631-852-2976
  • Fax: 631-852-3966
Mailing address:
  • Phone: 631-852-2976
  • Fax: 631-852-3966

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License NumberF301585
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: