Provider Demographics
NPI:1003019951
Name:BURKE, CAROL PATRICIA (CRNP LAC)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:PATRICIA
Last Name:BURKE
Suffix:
Gender:F
Credentials:CRNP LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1733 DREVAR TRAIL
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401
Mailing Address - Country:US
Mailing Address - Phone:410-849-3456
Mailing Address - Fax:
Practice Address - Street 1:645 RIDGELY AVENUE
Practice Address - Street 2:FULL CIRCLE HEALING ARTS
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401
Practice Address - Country:US
Practice Address - Phone:410-266-9370
Practice Address - Fax:410-266-3902
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDU01487171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist