Basic Information
| Provider Information | |||||||||
| NPI: | 1417465865 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BURNS | ||||||||
| FirstName: | TRACY | ||||||||
| MiddleName: | LEE | ||||||||
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| Credential: | CNM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4842 N BARRANCO DR | ||||||||
| Address2: | |||||||||
| City: | LITCHFIELD PARK | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853402738 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6233884783 | ||||||||
| FaxNumber: | 6233884783 | ||||||||
| Practice Location | |||||||||
| Address1: | 1170 N ESTRELLA PKWY STE A107 | ||||||||
| Address2: | |||||||||
| City: | GOODYEAR | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 853389276 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6238467558 | ||||||||
| FaxNumber: | 6238461674 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/19/2018 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367A00000X | AP10912 | AZ | Y | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
No ID Information.