Provider Demographics
NPI:1396492211
Name:BURKE, LEZLIE DAWN (MA)
Entity type:Individual
Prefix:
First Name:LEZLIE
Middle Name:DAWN
Last Name:BURKE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CMR 409 BOX 288
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09053-0003
Mailing Address - Country:US
Mailing Address - Phone:491-702-1682
Mailing Address - Fax:
Practice Address - Street 1:BUILDING 51 TRUPPENUEBUNGSPLATZ
Practice Address - Street 2:
Practice Address - City:HOHENFELS
Practice Address - State:AE
Practice Address - Zip Code:92366-0003
Practice Address - Country:US
Practice Address - Phone:491-702-1682
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-10
Last Update Date:2022-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACM61104519363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical