Individual
MS. TARA BURNETT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
4525 N CENTRAL AVE, PHOENIX, AZ 85012-1816
(602) 764-7511
Mailing address
4525 N CENTRAL AVE, PHOENIX, AZ 85012-1816
(602) 764-7511
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
LP026982
AZ
Other
Enumeration date
11/04/2011
Last updated
11/04/2011
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