Provider Demographics
NPI:1225798655
Name:BURKE, ADDI GRACE
Entity Type:Individual
Prefix:
First Name:ADDI
Middle Name:GRACE
Last Name:BURKE
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 1:107 MURRAY ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75226-1645
Mailing Address - Country:US
Mailing Address - Phone:469-608-0071
Mailing Address - Fax:
Practice Address - Street 1:107 MURRAY ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75226-1645
Practice Address - Country:US
Practice Address - Phone:469-608-0071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-27
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula