Provider Demographics
NPI:1912732363
Name:BURKS, KATRONA L (LPN/MDS COORDINATOR)
Entity type:Individual
Prefix:
First Name:KATRONA
Middle Name:L
Last Name:BURKS
Suffix:
Gender:F
Credentials:LPN/MDS COORDINATOR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2430 N GRANT BLVD
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53210-2940
Mailing Address - Country:US
Mailing Address - Phone:414-708-7570
Mailing Address - Fax:
Practice Address - Street 1:2430 N GRANT BLVD
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53210-2940
Practice Address - Country:US
Practice Address - Phone:414-708-7570
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-05
Last Update Date:2024-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI321584-31164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse