Provider Demographics
NPI:1740836725
Name:BURKETT, REBECCA ANNE (LM, CPM)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:ANNE
Last Name:BURKETT
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 N PINE ST APT 1
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48933-8002
Mailing Address - Country:US
Mailing Address - Phone:616-719-7361
Mailing Address - Fax:
Practice Address - Street 1:616 N PINE ST APT 1
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48933-8002
Practice Address - Country:US
Practice Address - Phone:616-719-7361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-14
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
176B00000X
MI7601000053176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife