Provider Demographics
NPI:1104158609
Name:BURK, JOHN CEDRIC (RN)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:CEDRIC
Last Name:BURK
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CMR 454 BOX 2008
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09250-2000
Mailing Address - Country:US
Mailing Address - Phone:01149908-283-3284
Mailing Address - Fax:
Practice Address - Street 1:USAMEDDAC BAVARIA
Practice Address - Street 2:CMR 411,BLDG 700, ROSE BARRACKS
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09112
Practice Address - Country:US
Practice Address - Phone:011499-662-8347
Practice Address - Fax:0114966-283-4721
Is Sole Proprietor?:No
Enumeration Date:2010-02-08
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002016170163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN