Provider Demographics
NPI:1982078531
Name:BURKE, ANTOINETTE P (PA-C, RD, CNSC)
Entity type:Individual
Prefix:
First Name:ANTOINETTE
Middle Name:P
Last Name:BURKE
Suffix:
Gender:
Credentials:PA-C, RD, CNSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3709 LEMON AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-4115
Mailing Address - Country:US
Mailing Address - Phone:610-739-9606
Mailing Address - Fax:
Practice Address - Street 1:3709 LEMON AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-4115
Practice Address - Country:US
Practice Address - Phone:610-739-9606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-19
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
86029200133V00000X
CA1193054363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered