MEDICARE: LAUREN ELIZABETH BURKE

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	390200000X	Student in an Organized Health Care Education/Training Program
2	363A00000X	Physician Assistant		SC

General Provider Information

NPI Number	:	1225654742
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAUREN ELIZABETH BURKE

Provider Business Mailing Address
First Line	:	41 DEEP LAKE DR
Second Line	:
City	:	MURRELLS INLET
State	:	SC
Zip	:	29576-5767
Country	:	US
Telephone Number	:	607-377-9310
Fax Number	:

Provider Business Practice Location Address
First Line	:	442 KING ST
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29403-6230
Country	:	US
Telephone Number	:	607-377-9310
Fax Number	:

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

Provider Enumeration Date	:	06/20/2020
Last Update Date	:	09/26/2024

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Directions to “ LAUREN ELIZABETH BURKE ” Practice Location

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