Provider Demographics
NPI:1528067568
Name:BURKETT, MARY ELIZABETH (CFNP)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:ELIZABETH
Last Name:BURKETT
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
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Mailing Address - Street 1:1360 N SAINT HELEN RD
Mailing Address - Street 2:P O BOX 39
Mailing Address - City:SAINT HELEN
Mailing Address - State:MI
Mailing Address - Zip Code:48656-9521
Mailing Address - Country:US
Mailing Address - Phone:989-389-4944
Mailing Address - Fax:989-389-1401
Practice Address - Street 1:1360 N SAINT HELEN RD
Practice Address - Street 2:
Practice Address - City:SAINT HELEN
Practice Address - State:MI
Practice Address - Zip Code:48656-9521
Practice Address - Country:US
Practice Address - Phone:989-389-4944
Practice Address - Fax:989-389-1401
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704110149363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4836749Medicaid
MI4836730Medicaid
MI5008773520OtherBCBS PIN
MI700G210140OtherBCBS GROUP
MI5008773520OtherBCBS PIN
MIS86544Medicare UPIN