MEDICARE: MRS. JACQUELIN P BURKE NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LX0001X	Obstetrics & Gynecology Nurse Practitioner	COA10347-NP	OH

General Provider Information

NPI Number	:	1063641603
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JACQUELIN P BURKE NP

Provider Business Mailing Address
First Line	:	605 N CLEVELAND MASSILLON RD
Second Line	:	STE A
City	:	AKRON
State	:	OH
Zip	:	44333-2200
Country	:	US
Telephone Number	:	330-668-6545
Fax Number	:	330-668-2726

Provider Business Practice Location Address
First Line	:	605 N CLEVELAND MASSILLON RD
Second Line	:	STE A
City	:	AKRON
State	:	OH
Zip	:	44333-2200
Country	:	US
Telephone Number	:	330-668-6545
Fax Number	:	330-668-2726

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/03/2009
Last Update Date	:	06/18/2015

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