Provider Demographics
NPI:1013683804
Name:BURKE, DEIRDRE JOHANNA (NP, MPH)
Entity Type:Individual
Prefix:
First Name:DEIRDRE
Middle Name:JOHANNA
Last Name:BURKE
Suffix:
Gender:F
Credentials:NP, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 MYOPIA RD
Mailing Address - Street 2:
Mailing Address - City:STONEHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02180-2271
Mailing Address - Country:US
Mailing Address - Phone:781-572-2375
Mailing Address - Fax:
Practice Address - Street 1:101 CAMBRIDGE ST STE 380
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:MA
Practice Address - Zip Code:01803-3741
Practice Address - Country:US
Practice Address - Phone:781-653-4281
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-20
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2337925363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care