Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 125.073235 | IL |
N | 111NI0900X | Internist | 125.073235 | IL |
N | 207R00000X | Internist | 69329 | MN |
N | 111NI0900X | Internist | 69329 | MN |
Y | 207RH0002X | Hospice and Palliative Medicine | 69329 | MN |
NPI | 1023504008 |
---|---|
Provider Name | Olivia Claire Burke |
First Address | Rochester, MN 55905-0001 |
Second Address | Rochester, MN 55905-2315 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2018 |
Last Update Date | 16/06/2021 |