Provider Demographics
NPI:1679262547
Name:BURK, MEGAN ELISE (RN, PHN)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:ELISE
Last Name:BURK
Suffix:
Gender:F
Credentials:RN, PHN
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:ELISE
Other - Last Name:LEVY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN, PHN
Mailing Address - Street 1:PO BOX 255228
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95865-5228
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2020 SUTTER PL STE 203
Practice Address - Street 2:
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-6217
Practice Address - Country:US
Practice Address - Phone:530-750-5880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-04
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA819391163WM0102X
CANM236440176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No163WM0102XNursing Service ProvidersRegistered NurseMaternal Newborn