Provider Demographics
NPI:1124511209
Name:BURKETT, ALANA MARIE (SA-C)
Entity type:Individual
Prefix:
First Name:ALANA
Middle Name:MARIE
Last Name:BURKETT
Suffix:
Gender:F
Credentials:SA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3206 CURTIS DR APT 811
Mailing Address - Street 2:
Mailing Address - City:TEMPLE HILLS
Mailing Address - State:MD
Mailing Address - Zip Code:20748-1267
Mailing Address - Country:US
Mailing Address - Phone:215-820-8259
Mailing Address - Fax:
Practice Address - Street 1:2984 KINCAID DR
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MD
Practice Address - Zip Code:20603-5784
Practice Address - Country:US
Practice Address - Phone:240-424-0038
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-12
Last Update Date:2019-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCSA0209246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant