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NPI 1104846112

NPI 1104846112 : CYNTHIA LONIGAN BURKES P.A. : COATS, NC

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General NPI Number Information
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    NPI Number           |    1104846112
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    Entity Type          |    Individual 
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    Provider Name        |    CYNTHIA LONIGAN BURKES P.A.
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    Gender               |    Female 
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Dates
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    Enumeration Date     |    07/20/2006
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    Last Update Date     |    07/09/2007
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Provider Practice Location Address
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    Address Line         |    25 NORTH JOHNSON STREET 
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    City                 |    COATS
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    State                |    NC
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    Zip                  |    27521
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    Country              |    US
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    Telephone            |    910-897-6423
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    Fax                  |    910-897-2540
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Provider Business Mailing Address
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    Address Line         |    PO BOX 819 
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    City                 |    COATS
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    State                |    NC
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    Zip                  |    27521-0819
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    Country              |    US
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    Telephone            |    910-897-6423
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    Fax                  |    910-897-2540
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Authorized Official
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    Title or Position    |    
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    Name                 |        
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    Credential           |    
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    Telephone            |    
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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    Taxonomy Code        |    363AM0700X
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    Taxonomy Name        |    Medical Physician Assistant
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    License Number       |    102972
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    License Number State |    NC
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