Provider Demographics
NPI:1164499208
Name:MOORE-BURKE, EDNA FAYE (CNP, MS, RN)
Entity Type:Individual
Prefix:
First Name:EDNA
Middle Name:FAYE
Last Name:MOORE-BURKE
Suffix:
Gender:F
Credentials:CNP, MS, RN
Other - Prefix:
Other - First Name:EDNA
Other - Middle Name:FAYE
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSN, RN
Mailing Address - Street 1:820 S DAMEN AVE
Mailing Address - Street 2:MP 118
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3728
Mailing Address - Country:US
Mailing Address - Phone:312-569-8387
Mailing Address - Fax:312-569-8123
Practice Address - Street 1:820 S DAMEN AVE
Practice Address - Street 2:MP 118
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3728
Practice Address - Country:US
Practice Address - Phone:312-569-8387
Practice Address - Fax:312-569-8123
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209002774363LA2100X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care