Basic Information
Provider Information
NPI: 1114206893
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BURKE
FirstName: DEBORAH
MiddleName: LYNN
NamePrefix: MRS.
NameSuffix:  
Credential: MS, PA-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 110429
Address2:  
City: AURORA
State: CO
PostalCode: 800420429
CountryCode: US
TelephoneNumber: 3034937000
FaxNumber:  
Practice Location
Address1: 13123 E 16TH AVE
Address2:  
City: AURORA
State: CO
PostalCode: 800457106
CountryCode: US
TelephoneNumber: 7207771234
FaxNumber:  
Other Information
ProviderEnumerationDate: 08/11/2011
LastUpdateDate: 10/23/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363A00000XPA-3234CON Physician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 
363AM0700XPA.0003234COY Physician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical

No ID Information.


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