Healthcare Provider Details

I. General information

NPI: 1487177440
Provider Name (Legal Business Name): JULIA COLE BURKE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2017
Last Update Date: 07/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 N MAIN ST
PROVIDENCE RI
02904-5762
US

IV. Provider business mailing address

104 EDGEHILL RD
PROVIDENCE RI
02906-1929
US

V. Phone/Fax

Practice location:
  • Phone: 401-274-2500
  • Fax:
Mailing address:
  • Phone: 401-455-6528
  • Fax: 401-455-6494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberAPRN01585
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: