Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | 71006572A | IN |
NPI | 1003273178 |
---|---|
Provider Name | Mrs. Renee Marie Burkhart |
First Address | Indianapolis, IN 46237-3628 |
Second Address | Indianapolis, IN 46237-3628 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/01/2016 |
Last Update Date | 13/10/2016 |