Provider Demographics
NPI:1255778593
Name:BURKE, ROSEANNE (WHNP)
Entity type:Individual
Prefix:
First Name:ROSEANNE
Middle Name:
Last Name:BURKE
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 S MICHIGAN AVE
Mailing Address - Street 2:FLOOR 6
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60603-3200
Mailing Address - Country:US
Mailing Address - Phone:312-592-6800
Mailing Address - Fax:312-592-6801
Practice Address - Street 1:1319 N VETERANS PKWY
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61704-6426
Practice Address - Country:US
Practice Address - Phone:309-827-4014
Practice Address - Fax:309-828-6626
Is Sole Proprietor?:No
Enumeration Date:2013-05-28
Last Update Date:2013-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209010389363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health