Provider Demographics
NPI:1073272969
Name:BURKE, REBECCA NILA (HCW)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:NILA
Last Name:BURKE
Suffix:
Gender:F
Credentials:HCW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:382 SW BIRCH ST
Mailing Address - Street 2:
Mailing Address - City:PILOT ROCK
Mailing Address - State:OR
Mailing Address - Zip Code:97868-6667
Mailing Address - Country:US
Mailing Address - Phone:509-929-1708
Mailing Address - Fax:
Practice Address - Street 1:382 SW BIRCH ST
Practice Address - Street 2:
Practice Address - City:PILOT ROCK
Practice Address - State:OR
Practice Address - Zip Code:97868-6667
Practice Address - Country:US
Practice Address - Phone:509-929-1708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-08
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR781615251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health