MEDICARE: MRS. MARY ELIZABETH BURKETT CFNP

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	363L00000X	Nurse Practitioner	4704110149	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	5008773520	OTHER	MI	BCBS PIN
4	700G210140	OTHER	MI	BCBS GROUP

General Provider Information

NPI Number	:	1528067568
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARY ELIZABETH BURKETT CFNP

Provider Business Mailing Address
First Line	:	1360 N SAINT HELEN RD
Second Line	:	P O BOX 39
City	:	SAINT HELEN
State	:	MI
Zip	:	48656-9521
Country	:	US
Telephone Number	:	989-389-4944
Fax Number	:	989-389-1401

Provider Business Practice Location Address
First Line	:	1360 N SAINT HELEN RD
Second Line	:
City	:	SAINT HELEN
State	:	MI
Zip	:	48656-9521
Country	:	US
Telephone Number	:	989-389-4944
Fax Number	:	989-389-1401

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

Provider Enumeration Date	:	07/20/2005
Last Update Date	:	01/27/2009

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