Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | MD00017576 | WA |
Y | 111NI0900X | Internist | MD00017576 | WA |
N | 207SG0201X | Clinical Genetics (M.D.) | MD00017576 | WA |
NPI | 1427133222 |
---|---|
Provider Name | Wylie Gilman Burke |
First Address | Seattle, WA 98145-5095 |
Second Address | Seattle, WA 98195-6127 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/10/2006 |
Last Update Date | 06/12/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1427133222 | (05) | WA |
1778 | INTERNAL ID-MOTOR VEHICLE ID (01) | |
B18182 | (02) |