Healthcare Provider Details

I. General information

NPI: 1720224736
Provider Name (Legal Business Name): NATHAN E BURKE CST
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2008
Last Update Date: 12/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3205 WOODMAN DR
DAYTON OH
45420-1143
US

IV. Provider business mailing address

3205 WOODMAN DR
DAYTON OH
45420-1143
US

V. Phone/Fax

Practice location:
  • Phone: 937-298-4417
  • Fax: 937-298-8260
Mailing address:
  • Phone: 937-298-4417
  • Fax: 937-298-8260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: