Provider Demographics
NPI:1194997981
Name:BURKE, JAIME EUGENA (HIS)
Entity type:Individual
Prefix:
First Name:JAIME
Middle Name:EUGENA
Last Name:BURKE
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:JAIME
Other - Middle Name:EUGENA
Other - Last Name:NICHOLS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:HIS
Mailing Address - Street 1:817 W BROADWAY
Mailing Address - Street 2:SUITE A
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-5699
Mailing Address - Country:US
Mailing Address - Phone:505-326-5707
Mailing Address - Fax:505-326-4026
Practice Address - Street 1:817 W BROADWAY
Practice Address - Street 2:SUITE A
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-5699
Practice Address - Country:US
Practice Address - Phone:505-326-5707
Practice Address - Fax:505-326-4026
Is Sole Proprietor?:No
Enumeration Date:2008-04-01
Last Update Date:2010-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0696237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist