Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 0024166500 | VA |
NPI | 1013904374 |
---|---|
Provider Name | Ms. Laurie Powell Burke |
First Address | Midlothian, VA 23112-3989 |
Second Address | Midlothian, VA 23112-3989 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2005 |
Last Update Date | 08/07/2007 |