Provider Demographics
NPI:1609334093
Name:BURKE, CHRISTINA NOEL (AGNP-C)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINA
Middle Name:NOEL
Last Name:BURKE
Suffix:
Gender:F
Credentials:AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12501 WILLOWBROOK RD
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-2569
Mailing Address - Country:US
Mailing Address - Phone:301-707-1475
Mailing Address - Fax:
Practice Address - Street 1:12501 WILLOWBROOK RD
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-2569
Practice Address - Country:US
Practice Address - Phone:301-759-5125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-05
Last Update Date:2019-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR190354363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner