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General NPI Number Information
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NPI Number | 1902247778
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Entity Type | Individual
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Provider Name | PRENTISS BURKE
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Gender | Female
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Dates
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Enumeration Date | 07/09/2013
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Last Update Date | 07/09/2013
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Provider Practice Location Address
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Address Line | 1223 27TH AVE
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City | FAIRBANKS
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State | ALASKA
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Zip | 99701
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Country | UM
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Telephone | 404-259-7674
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Fax |
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Provider Business Mailing Address
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Address Line | 1223 27TH AVE
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City | FAIRBANKS
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State | AK
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Zip | 99701-6837
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Country | US
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Telephone |
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Fax |
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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 | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 081170
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 376K00000X
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Taxonomy Name | Nurse's Aide
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License Number | 77580
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number | 61932
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License Number State | TN
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