Provider Demographics
NPI:1477966349
Name:BURK, CAITLIN SUE (PA-C)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:SUE
Last Name:BURK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CAITLIN
Other - Middle Name:SUE
Other - Last Name:BETTGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9201 W BROADWAY AVE STE 601
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55445-1924
Mailing Address - Country:US
Mailing Address - Phone:763-587-7900
Mailing Address - Fax:763-587-7066
Practice Address - Street 1:9825 HOSPITAL DRIVE
Practice Address - Street 2:SUITE 300
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369
Practice Address - Country:US
Practice Address - Phone:763-587-7900
Practice Address - Fax:763-494-7501
Is Sole Proprietor?:No
Enumeration Date:2014-06-08
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN11544363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical