Provider Demographics
NPI:1659794865
Name:BURKE-BANCROFT, THORNIA
Entity Type:Individual
Prefix:
First Name:THORNIA
Middle Name:
Last Name:BURKE-BANCROFT
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 1:683 BARBEY ST
Mailing Address - Street 2:APT 515
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11207-6038
Mailing Address - Country:US
Mailing Address - Phone:718-485-3496
Mailing Address - Fax:
Practice Address - Street 1:683 BARBEY ST
Practice Address - Street 2:APT 515
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11207-6038
Practice Address - Country:US
Practice Address - Phone:718-485-3496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-23
Last Update Date:2014-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY677778163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse