Individual
CLINT BURGESS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
4463 E DES MOINES ST, MESA, AZ 85205-6340
(480) 766-9828
Mailing address
4463 E DES MOINES ST, MESA, AZ 85205-6340
(480) 766-9828
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
234960
AZ
363LF0000X
Family Nurse Practitioner
TEMP234960
AZ
Other
Enumeration date
01/21/2020
Last updated
10/09/2023
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