MEDICARE: MS. REBECCA CHARLOTTE BURKE WHNP-BC

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	363LW0102X	Women's Health Nurse Practitioner	R206652	MD

General Provider Information

NPI Number	:	1255845756
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. REBECCA CHARLOTTE BURKE WHNP-BC

Provider Business Mailing Address
First Line	:	5710 DETRICK RD
Second Line	:
City	:	MOUNT AIRY
State	:	MD
Zip	:	21771-6132
Country	:	US
Telephone Number	:	240-372-5014
Fax Number	:

Provider Business Practice Location Address
First Line	:	10801 LOCKWOOD DR STE 300
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20901-1562
Country	:	US
Telephone Number	:	301-681-0004
Fax Number	:

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

Provider Enumeration Date	:	11/21/2017
Last Update Date	:	11/21/2017

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