Provider Demographics
NPI:1053798835
Name:BURKS, MARY (RN)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:BURKS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6719 COUNTY ROAD 33
Mailing Address - Street 2:
Mailing Address - City:SKIPPERVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:36374-7723
Mailing Address - Country:US
Mailing Address - Phone:334-733-5206
Mailing Address - Fax:
Practice Address - Street 1:6719 COUNTY ROAD 33
Practice Address - Street 2:
Practice Address - City:SKIPPERVILLE
Practice Address - State:AL
Practice Address - Zip Code:36374-7723
Practice Address - Country:US
Practice Address - Phone:334-733-5206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-30
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-139679163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse