Provider Demographics
NPI:1154510568
Name:BURKET, SEAN M (CRNP)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:M
Last Name:BURKET
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:207 N BROAD ST
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-1500
Mailing Address - Country:US
Mailing Address - Phone:267-479-4142
Mailing Address - Fax:215-463-3820
Practice Address - Street 1:255 WEST LANCASTER AVENUE
Practice Address - Street 2:BLDG 2 - SUITE 328
Practice Address - City:PAOLI
Practice Address - State:PA
Practice Address - Zip Code:19301-1766
Practice Address - Country:US
Practice Address - Phone:610-647-2400
Practice Address - Fax:610-647-3902
Is Sole Proprietor?:No
Enumeration Date:2007-10-22
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP009817363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1031628290001Medicaid