Provider Demographics
NPI:1205595881
Name:BURKS, ANDREA RENEE
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:RENEE
Last Name:BURKS
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 1:24 PARADOR CT
Mailing Address - Street 2:
Mailing Address - City:LOS LUNAS
Mailing Address - State:NM
Mailing Address - Zip Code:87031-7355
Mailing Address - Country:US
Mailing Address - Phone:719-964-0240
Mailing Address - Fax:
Practice Address - Street 1:24 PARADOR CT
Practice Address - Street 2:
Practice Address - City:LOS LUNAS
Practice Address - State:NM
Practice Address - Zip Code:87031-7355
Practice Address - Country:US
Practice Address - Phone:719-964-0240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-11
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider