Provider Demographics
NPI:1336857861
Name:BURKE, KERRY ANNE
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:ANNE
Last Name:BURKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KERRY
Other - Middle Name:ANNE
Other - Last Name:BURKE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:12 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ALLENTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08501-1607
Mailing Address - Country:US
Mailing Address - Phone:609-213-6055
Mailing Address - Fax:
Practice Address - Street 1:12 N MAIN ST
Practice Address - Street 2:
Practice Address - City:ALLENTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08501-1607
Practice Address - Country:US
Practice Address - Phone:609-213-6055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-14
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0450547947OtherSOLE PROVIDER