Healthcare Provider Details

I. General information

NPI: 1932123981
Provider Name (Legal Business Name): JULIA MARIE BURKE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 12TH AVE BUILDING A
ALTOONA PA
16601-3100
US

IV. Provider business mailing address

1701 12TH AVE BUILDING A
ALTOONA PA
16601-3100
US

V. Phone/Fax

Practice location:
  • Phone: 814-944-7097
  • Fax: 814-944-5557
Mailing address:
  • Phone: 814-944-7097
  • Fax: 814-944-5557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA000592L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: