Provider Demographics
NPI:1881209773
Name:BURCKER, KARISSA HOPE
Entity Type:Individual
Prefix:
First Name:KARISSA
Middle Name:HOPE
Last Name:BURCKER
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 1:29 SOPWITH WAY
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25401-6311
Mailing Address - Country:US
Mailing Address - Phone:304-995-9712
Mailing Address - Fax:
Practice Address - Street 1:29 SOPWITH WAY
Practice Address - Street 2:
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-6311
Practice Address - Country:US
Practice Address - Phone:304-995-9712
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-09
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant