Provider Demographics
NPI:1487837647
Name:BURKE, OLIVE C
Entity Type:Individual
Prefix:MRS
First Name:OLIVE
Middle Name:C
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 1:2025 N 3RD ST
Mailing Address - Street 2:SUITE 170
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85004-1471
Mailing Address - Country:US
Mailing Address - Phone:602-462-1132
Mailing Address - Fax:
Practice Address - Street 1:2025 N 3RD ST
Practice Address - Street 2:SUITE 170
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85004-1471
Practice Address - Country:US
Practice Address - Phone:602-462-1132
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-11
Last Update Date:2007-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN079261163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse