Provider Demographics
NPI:1609305705
Name:BURKE, RACHEL ANN (CNP)
Entity type:Individual
Prefix:
First Name:RACHEL
Middle Name:ANN
Last Name:BURKE
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:ANN
Other - Last Name:HEMMELGARN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6480 HARRISON AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45247-7961
Mailing Address - Country:US
Mailing Address - Phone:513-713-1779
Mailing Address - Fax:138-549-9215
Practice Address - Street 1:3205 WOODMAN DR
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45420-1143
Practice Address - Country:US
Practice Address - Phone:937-298-4417
Practice Address - Fax:937-298-8260
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-12
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.020959363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0231310Medicaid