MEDICARE: COLLEEN BURKART APN

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	363LF0000X	Family Nurse Practitioner	209003998	IL

General Provider Information

NPI Number	:	1073785101
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	COLLEEN BURKART APN

Provider Business Mailing Address
First Line	:	9951 ROCK CUT XING
Second Line	:
City	:	LOVES PARK
State	:	IL
Zip	:	61111-1999
Country	:	US
Telephone Number	:	815-921-8900
Fax Number	:

Provider Business Practice Location Address
First Line	:	7219 WALTON ST
Second Line	:
City	:	ROCKFORD
State	:	IL
Zip	:	61108-2607
Country	:	US
Telephone Number	:	815-921-8900
Fax Number	:

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

Provider Enumeration Date	:	03/28/2008
Last Update Date	:	09/16/2011

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Directions to “ COLLEEN BURKART APN” Practice Location

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