Provider Demographics
NPI:1629014410
Name:BURKE, CATHERINE ANN (CNM)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:ANN
Last Name:BURKE
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 WEST AVE
Mailing Address - Street 2:
Mailing Address - City:BROCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14420-1118
Mailing Address - Country:US
Mailing Address - Phone:585-637-3905
Mailing Address - Fax:585-637-4990
Practice Address - Street 1:300 WEST AVE
Practice Address - Street 2:
Practice Address - City:BROCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14420-1118
Practice Address - Country:US
Practice Address - Phone:585-637-3905
Practice Address - Fax:585-637-4990
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF000071-1367A00000X
NY406781-1163W00000X
NY000071367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000919124002OtherHEALTHNOWBCBSWNY ALBION#
NY010100071OtherEXCELLUS
NY5090687OtherINDEPENDENT HEALTH
NY7649238OtherAETNA PPO/POS
NY000919124001OtherHEALTHNOW BCBSWNY BRCKPT#
NY01685625Medicaid
NY7701053OtherMVP SELECT CARE
NY102984CQOtherPREFERRED CARE
NY040426004447OtherFIDELIS
NY2593586OtherAETNA HMO