Healthcare Provider Details

I. General information

NPI: 1104278308
Provider Name (Legal Business Name): JULIE BURKE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2016
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3075 VANDERCAR WAY
CINCINNATI OH
45209-7542
US

IV. Provider business mailing address

3075 VANDERCAR WAY
CINCINNATI OH
45209-7542
US

V. Phone/Fax

Practice location:
  • Phone: 657-309-1619
  • Fax:
Mailing address:
  • Phone: 216-310-5384
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN.CNP.019415
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: