Provider Demographics
NPI:1679197115
Name:BURKE, MARY ELLEN
Entity Type:Individual
Prefix:
First Name:MARY ELLEN
Middle Name:
Last Name:BURKE
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 1:14 W PARSONS DR
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:MA
Mailing Address - Zip Code:01341-9777
Mailing Address - Country:US
Mailing Address - Phone:413-834-3276
Mailing Address - Fax:
Practice Address - Street 1:14 W PARSONS DR
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:MA
Practice Address - Zip Code:01341-9777
Practice Address - Country:US
Practice Address - Phone:413-834-3276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-01
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN239324176B00000X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No176B00000XOther Service ProvidersMidwife