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Individual
MRS. MARY ELIZABETH BURKETT
Active
Individual
MRS. MARY ELIZABETH BURKETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CFNP
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
4704110149
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4836730
—
MI
05
—
4836749
—
MI
01
—
5008773520
BCBS PIN
MI
01
—
700G210140
BCBS GROUP
MI
Enumeration date
07/20/2005
Last updated
01/27/2009
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