Provider Demographics
NPI:1073578712
Name:SPIVEY-BURKE, VANESSA LEE (MS, APRN,BC - GNP)
Entity Type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:LEE
Last Name:SPIVEY-BURKE
Suffix:
Gender:F
Credentials:MS, APRN,BC - GNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:336-13 COMMACK RD
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11729
Mailing Address - Country:US
Mailing Address - Phone:631-586-7246
Mailing Address - Fax:631-254-5132
Practice Address - Street 1:79 MIDDLEVILLE RD
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:NY
Practice Address - Zip Code:11768-2200
Practice Address - Country:US
Practice Address - Phone:631-261-4400
Practice Address - Fax:631-254-5132
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2010-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF340161-1363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology