Healthcare Provider Details

I. General information

NPI: 1477542363
Provider Name (Legal Business Name): KATHLEEN ANN BURKE WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/14/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

654 S 900 E
SALT LAKE CITY UT
84102-3478
US

IV. Provider business mailing address

1589 PRINCETON AVE
SALT LAKE CITY UT
84105-1735
US

V. Phone/Fax

Practice location:
  • Phone: 801-521-2744
  • Fax: 801-532-5748
Mailing address:
  • Phone: 801-583-0744
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number5124377-4405
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: