Provider Demographics
NPI:1215491261
Name:BURKERT, RAVEN P (FNP)
Entity type:Individual
Prefix:MRS
First Name:RAVEN
Middle Name:P
Last Name:BURKERT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MS
Other - First Name:RAVEN
Other - Middle Name:P
Other - Last Name:OSSIVAND
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MARRIED NAME
Mailing Address - Street 1:679 E COUNTY LINE RD
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-1049
Mailing Address - Country:US
Mailing Address - Phone:317-859-7222
Mailing Address - Fax:317-859-7220
Practice Address - Street 1:679 E COUNTY LINE RD
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-1049
Practice Address - Country:US
Practice Address - Phone:317-859-7222
Practice Address - Fax:317-859-7220
Is Sole Proprietor?:No
Enumeration Date:2019-01-24
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28195639A163WE0003X
IN71009712A363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WE0003XNursing Service ProvidersRegistered NurseEmergency
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN28195639AOtherINDIANA STATE BOARD OF NURSING
1487680518OtherGROUP NPI