Provider Demographics
NPI:1518108539
Name:BURK, DAVID RICHARD (LPN)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:RICHARD
Last Name:BURK
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:276 THOMAS CT
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59602-7144
Mailing Address - Country:US
Mailing Address - Phone:406-539-2355
Mailing Address - Fax:
Practice Address - Street 1:276 THOMAS CT
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59602-7144
Practice Address - Country:US
Practice Address - Phone:406-539-2355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-20
Last Update Date:2009-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT37324164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse