Provider Demographics
NPI:1306485636
Name:BURLEN-DAVIS, KATIE (DNP, FNP-BC)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:BURLEN-DAVIS
Suffix:
Gender:F
Credentials:DNP, FNP-BC
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:BURLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1234 BORG AVE
Mailing Address - Street 2:
Mailing Address - City:TEMPERANCE
Mailing Address - State:MI
Mailing Address - Zip Code:48182-2606
Mailing Address - Country:US
Mailing Address - Phone:419-206-2713
Mailing Address - Fax:
Practice Address - Street 1:9045 WOODWARD AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202
Practice Address - Country:US
Practice Address - Phone:419-206-2713
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-03
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0028007363LF0000X
MI4704336083363LF0000X
OH4704336083163W00000X
OH406155163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse