Basic Information
Provider Information
NPI: 1336113240
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BURKE
FirstName: PATRICIA
MiddleName: A.
NamePrefix:  
NameSuffix:  
Credential: APNP
OtherOrganizationName:  
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Mailing Information
Address1: WAUKESHA HEALTH CARE INC.
Address2: N17 W24100 RIVERWOOD DRIVE SUITE 250
City: WAUKESHA
State: WI
PostalCode: 531881177
CountryCode: US
TelephoneNumber: 2629284100
FaxNumber: 2629285835
Practice Location
Address1: COMMUNITY NURSING CLINIC AT WCTC
Address2: 800 MAIN STREET ROOM SO173
City: PEWAUKEE
State: WI
PostalCode: 53072
CountryCode: US
TelephoneNumber: 2626951888
FaxNumber: 2626951884
Other Information
ProviderEnumerationDate: 02/15/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
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IsSoleProprietor: X
IsOrganizationSubpart:  
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AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363L00000X713WIY Physician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner 

No ID Information.


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