Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | RN2337925 | MA |
NPI | 1013683804 |
---|---|
Provider Name | Deirdre Johanna Burke |
First Address | Stoneham, MA 02180-2271 |
Second Address | Burlington, MA 01803-3741 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/08/2021 |
Last Update Date | 20/08/2021 |