Provider Demographics
NPI:1669662078
Name:BURKETT, JENNY SIGEL (RN)
Entity Type:Individual
Prefix:MS
First Name:JENNY
Middle Name:SIGEL
Last Name:BURKETT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 827 BOX 1000
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AE
Mailing Address - Zip Code:09617
Mailing Address - Country:IT
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:PSC 827 BOX 306
Practice Address - Street 2:
Practice Address - City:FPO
Practice Address - State:AE
Practice Address - Zip Code:09617
Practice Address - Country:IT
Practice Address - Phone:081-811-6324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-01
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001155609163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine