Provider Demographics
NPI:1255845756
Name:BURKE, REBECCA CHARLOTTE (WHNP-BC)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:CHARLOTTE
Last Name:BURKE
Suffix:
Gender:F
Credentials:WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5710 DETRICK RD
Mailing Address - Street 2:
Mailing Address - City:MOUNT AIRY
Mailing Address - State:MD
Mailing Address - Zip Code:21771-6132
Mailing Address - Country:US
Mailing Address - Phone:240-372-5014
Mailing Address - Fax:
Practice Address - Street 1:10801 LOCKWOOD DR STE 300
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20901-1562
Practice Address - Country:US
Practice Address - Phone:301-681-0004
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-21
Last Update Date:2017-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR206652363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health