Provider Demographics
NPI:1215644869
Name:BURKE, ERIN O'CONNELL (CNP)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:O'CONNELL
Last Name:BURKE
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10359 S HOMAN AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60655-2422
Mailing Address - Country:US
Mailing Address - Phone:312-330-3910
Mailing Address - Fax:
Practice Address - Street 1:2100 CLEARWATER DR
Practice Address - Street 2:
Practice Address - City:OAK BROOK
Practice Address - State:IL
Practice Address - Zip Code:60523-1927
Practice Address - Country:US
Practice Address - Phone:630-607-1000
Practice Address - Fax:630-607-1002
Is Sole Proprietor?:No
Enumeration Date:2022-11-02
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209023433363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1164567236OtherBCBS
IL1164567236Medicaid