Provider Demographics
NPI:1013904374
Name:BURKE, LAURIE POWELL (RN, NP, CS)
Entity Type:Individual
Prefix:MS
First Name:LAURIE
Middle Name:POWELL
Last Name:BURKE
Suffix:
Gender:F
Credentials:RN, NP, CS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13506 EAST BOUNDARY ROAD
Mailing Address - Street 2:SUITE A
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23112-3989
Mailing Address - Country:US
Mailing Address - Phone:804-744-6714
Mailing Address - Fax:804-744-1265
Practice Address - Street 1:13506 EAST BOUNDARY ROAD
Practice Address - Street 2:SUITE A
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23112-3989
Practice Address - Country:US
Practice Address - Phone:804-744-6714
Practice Address - Fax:804-744-1265
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024166500363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health