Provider Demographics
NPI:1396263448
Name:BURKE, LAUREN
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:BURKE
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 1:70 HIGHLAND ST APT E
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03264-1251
Mailing Address - Country:US
Mailing Address - Phone:973-303-8624
Mailing Address - Fax:
Practice Address - Street 1:70 HIGHLAND STREET
Practice Address - Street 2:APARTMENT E
Practice Address - City:PLYMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03264
Practice Address - Country:US
Practice Address - Phone:973-303-8624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-08
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer