Provider Demographics
NPI:1306193776
Name:BURKE, KIMBERLEE SUZANNE (APN)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLEE
Middle Name:SUZANNE
Last Name:BURKE
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25230 S PLAINVIEW DR
Mailing Address - Street 2:
Mailing Address - City:CHANNAHON
Mailing Address - State:IL
Mailing Address - Zip Code:60410-5554
Mailing Address - Country:US
Mailing Address - Phone:708-717-3509
Mailing Address - Fax:
Practice Address - Street 1:400 N HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:IL
Practice Address - Zip Code:60506-3814
Practice Address - Country:US
Practice Address - Phone:630-978-2532
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-05
Last Update Date:2012-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209009669363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily