Provider Demographics
NPI:1336375526
Name:BURON, JACQUELINE MICHELE (ACNP)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:MICHELE
Last Name:BURON
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:MS
Other - First Name:JACQUELINE
Other - Middle Name:MICHELE
Other - Last Name:BETHKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ACNP
Mailing Address - Street 1:600 NORTH WOLFE STREET
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21287
Mailing Address - Country:US
Mailing Address - Phone:410-502-1048
Mailing Address - Fax:410-502-1047
Practice Address - Street 1:600 NORTH WOLFE STREET
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21045
Practice Address - Country:US
Practice Address - Phone:410-502-1048
Practice Address - Fax:410-502-1047
Is Sole Proprietor?:No
Enumeration Date:2009-06-02
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR121786363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care