Basic Information
| Provider Information | |||||||||
| NPI: | 1811008634 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BURKE | ||||||||
| FirstName: | KATHLEEN | ||||||||
| MiddleName: | |||||||||
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| Credential: | R.N.C.,M.S., N.P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 526 MAIN ST 302 | ||||||||
| Address2: | |||||||||
| City: | ACTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 017203301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9783717010 | ||||||||
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| Practice Location | |||||||||
| Address1: | 340 MAPLE ST 201 | ||||||||
| Address2: | |||||||||
| City: | MARLBOROUGH | ||||||||
| State: | MA | ||||||||
| PostalCode: | 017523200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5084609613 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2006 | ||||||||
| LastUpdateDate: | 10/13/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0200X | 165067 | MA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
ID Information
| ID | Type | State | Issuer | Description | MB03805471 | 01 | MA | STATE CONTROLLED SUBSTANC | OTHER | 53313 | 01 | MA | FALLEN COMMUNITY HEALTH C | OTHER | MB0225018 | 01 | MA | FEDERAL DEA | OTHER | NP1970 | 01 | MA | BC/BS | OTHER |