Healthcare Provider Details

I. General information

NPI: 1437111044
Provider Name (Legal Business Name): LORRIE A BURK CNNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2006
Last Update Date: 11/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

902 MCCALLIE AVE
CHATTANOOGA TN
37403-2724
US

IV. Provider business mailing address

902 MCCALLIE AVE
CHATTANOOGA TN
37403-2724
US

V. Phone/Fax

Practice location:
  • Phone: 423-664-4460
  • Fax: 423-664-4466
Mailing address:
  • Phone: 423-664-4460
  • Fax: 423-648-5675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License NumberAPN0000010631
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: