Provider Demographics
NPI:1144500729
Name:BURNHAM, NICOLE LYNN (RN)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:LYNN
Last Name:BURNHAM
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4538 N ARTESIAN AVE
Mailing Address - Street 2:#2
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-3004
Mailing Address - Country:US
Mailing Address - Phone:773-550-9388
Mailing Address - Fax:
Practice Address - Street 1:4538 N ARTESIAN AVE
Practice Address - Street 2:#2
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60625-3004
Practice Address - Country:US
Practice Address - Phone:773-550-9388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-26
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041.394818163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse