Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 209004190 | IL |
NPI | 1003135864 |
---|---|
Provider Name | Elaine L Burcham |
First Address | Vincennes, IN 47591 |
Second Address | Vincennes, IN 47591 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2010 |
Last Update Date | 31/03/2014 |