Basic Information
| Provider Information | |||||||||
| NPI: | 1972583482 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BURKE | ||||||||
| FirstName: | SANDRA | ||||||||
| MiddleName: | MICHELLE | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | RNFA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14114 MARY SUE CT | ||||||||
| Address2: | |||||||||
| City: | SUGAR LAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 774782371 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2813926797 | ||||||||
| FaxNumber: | 2813923666 | ||||||||
| Practice Location | |||||||||
| Address1: | 5618 MEDICAL CENTER DR | ||||||||
| Address2: | |||||||||
| City: | KATY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 774946308 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2813926797 | ||||||||
| FaxNumber: | 2813923666 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/19/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WX0800X | 545490 | TX | Y | Nursing Service Providers | Registered Nurse | Orthopedic |
No ID Information.