Provider Demographics
NPI:1003273178
Name:BURKHART, RENEE MARIE
Entity Type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:MARIE
Last Name:BURKHART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7825 MCFARLAND LN
Mailing Address - Street 2:SUITE A
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46237-3628
Mailing Address - Country:US
Mailing Address - Phone:317-887-5500
Mailing Address - Fax:317-887-4806
Practice Address - Street 1:7825 MCFARLAND LN
Practice Address - Street 2:SUITE A
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-3628
Practice Address - Country:US
Practice Address - Phone:317-887-5500
Practice Address - Fax:317-887-4806
Is Sole Proprietor?:No
Enumeration Date:2016-01-20
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71006572A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner