Healthcare Provider Details

I. General information

NPI: 1972583482
Provider Name (Legal Business Name): SANDRA MICHELLE BURKE RNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5618 MEDICAL CENTER DR
KATY TX
77494-6308
US

IV. Provider business mailing address

14114 MARY SUE CT
SUGAR LAND TX
77478-2371
US

V. Phone/Fax

Practice location:
  • Phone: 281-392-6797
  • Fax: 281-392-3666
Mailing address:
  • Phone: 281-392-6797
  • Fax: 281-392-3666

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0800X
TaxonomyOrthopedic Registered Nurse
License Number545490
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: