Provider Demographics
NPI:1205160660
Name:BURKE, CYNTHIA MICHELE (RN, PNP, CNS)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:MICHELE
Last Name:BURKE
Suffix:
Gender:F
Credentials:RN, PNP, CNS
Other - Prefix:
Other - First Name:CINDY
Other - Middle Name:MICHELE
Other - Last Name:BLACKMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:505 PARNASSUS AVE
Mailing Address - Street 2:RM M649
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143-2204
Mailing Address - Country:US
Mailing Address - Phone:415-353-1649
Mailing Address - Fax:415-353-1926
Practice Address - Street 1:505 PARNASSUS AVE
Practice Address - Street 2:RM M649
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-2204
Practice Address - Country:US
Practice Address - Phone:415-353-1649
Practice Address - Fax:415-353-1926
Is Sole Proprietor?:No
Enumeration Date:2009-10-01
Last Update Date:2009-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13541363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics