Provider Demographics
NPI:1093006264
Name:BURKERN, ELIZABETH KAY
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:KAY
Last Name:BURKERN
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 1:6027 SW KELLY AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-3732
Mailing Address - Country:US
Mailing Address - Phone:503-260-5852
Mailing Address - Fax:
Practice Address - Street 1:6027 SW KELLY AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-3732
Practice Address - Country:US
Practice Address - Phone:503-260-5852
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-22
Last Update Date:2011-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR200941767RN163W00000X
WARN60117895163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse