Individual
MS. AMANDA BANCROFT BURRAGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D. M.P.H.
Contact information
Practice address
167 MAIN ST., TUBA CITY, AZ 86045
(866) 976-5941
Mailing address
167 MAIN ST., TUBA CITY, AZ 86045
(617) 921-9084
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
76475
GA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/23/2013
Last updated
03/06/2020
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