Provider Demographics
NPI:1972583839
Name:BURKE, DELINA J (MPH, CNM)
Entity type:Individual
Prefix:
First Name:DELINA
Middle Name:J
Last Name:BURKE
Suffix:
Gender:F
Credentials:MPH, CNM
Other - Prefix:
Other - First Name:DELINA
Other - Middle Name:
Other - Last Name:HOLMES, FOSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3204 BLUE HILL AVE
Mailing Address - Street 2:
Mailing Address - City:GALLUP
Mailing Address - State:NM
Mailing Address - Zip Code:87301-6933
Mailing Address - Country:US
Mailing Address - Phone:505-863-8144
Mailing Address - Fax:505-863-8144
Practice Address - Street 1:517 NIZHONI BLVD
Practice Address - Street 2:
Practice Address - City:GALLUP
Practice Address - State:NM
Practice Address - Zip Code:87301-5757
Practice Address - Country:US
Practice Address - Phone:505-722-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH027306-23-01176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife