Provider Demographics
NPI:1669838876
Name:BURKINS, RAQUEL (RN)
Entity Type:Individual
Prefix:
First Name:RAQUEL
Middle Name:
Last Name:BURKINS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:RAQUEL
Other - Middle Name:
Other - Last Name:BLACKSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:1811 WOODLAWN DR
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21207-4043
Mailing Address - Country:US
Mailing Address - Phone:410-887-1332
Mailing Address - Fax:
Practice Address - Street 1:1811 WOODLAWN DR
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21207-4043
Practice Address - Country:US
Practice Address - Phone:410-887-1332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-05
Last Update Date:2016-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR210195163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse