Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | A113907 | CA |
Y | 207P00000X | Emergency Physician | MD0410290 | DC |
NPI | 1013224591 |
---|---|
Provider Name | Guenevere Vanessa Burke |
First Address | Washington, DC 20037-1527 |
Second Address | Washington, DC 20422-0001 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/09/2010 |
Last Update Date | 06/08/2013 |