Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP2300X | Nurse Practitioner - Primary Care | APRN.CNP.0029104 | OH |
NPI | 1033873880 |
---|---|
Provider Name | Kathleen Marable Burke |
First Address | Grove City, OH 43123-9827 |
Second Address | Grove City, OH 43123-9827 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2021 |
Last Update Date | 27/10/2021 |