Provider Demographics
NPI:1134537681
Name:BURKE, ADRIENNE NICOLE
Entity type:Individual
Prefix:MRS
First Name:ADRIENNE
Middle Name:NICOLE
Last Name:BURKE
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:ADRIENNE
Other - Middle Name:
Other - Last Name:KOMASARA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:41060 NORTHWIND DR
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188-3115
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:41060 NORTHWIND DR
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48188-3115
Practice Address - Country:US
Practice Address - Phone:248-909-8847
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-29
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other