Provider Demographics
NPI:1144403205
Name:BURKE, ERIN JESSICA (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:JESSICA
Last Name:BURKE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3622 WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:METAMORA
Mailing Address - State:MI
Mailing Address - Zip Code:48455-9626
Mailing Address - Country:US
Mailing Address - Phone:586-354-0571
Mailing Address - Fax:
Practice Address - Street 1:4100 BEECHER RD
Practice Address - Street 2:SUITE A
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-3605
Practice Address - Country:US
Practice Address - Phone:810-342-3800
Practice Address - Fax:810-342-3784
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-12
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601005185363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant