Provider Demographics
NPI:1619605680
Name:BURKE, KATHLEEN CECELIA (RN IBCLC)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:CECELIA
Last Name:BURKE
Suffix:
Gender:F
Credentials:RN IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:558 DELAWARE AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:DELMAR
Mailing Address - State:NY
Mailing Address - Zip Code:12054-2819
Mailing Address - Country:US
Mailing Address - Phone:518-928-8135
Mailing Address - Fax:
Practice Address - Street 1:558 DELAWARE AVE APT 4
Practice Address - Street 2:
Practice Address - City:DELMAR
Practice Address - State:NY
Practice Address - Zip Code:12054-2819
Practice Address - Country:US
Practice Address - Phone:518-928-8135
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-09
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY307101-01163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant