MEDICARE: MRS. BECKY WARNER BURNS TEACHER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171W00000X	Contractor

General Provider Information

NPI Number	:	1427534908
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BECKY WARNER BURNS TEACHER

Provider Business Mailing Address
First Line	:	1638 ALLISON DR
Second Line	:
City	:	NEW BRAUNFELS
State	:	TX
Zip	:	78130-7752
Country	:	US
Telephone Number	:	406-750-0335
Fax Number	:

Provider Business Practice Location Address
First Line	:	7300 N DYSART RD
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85307-2218
Country	:	US
Telephone Number	:	623-876-7300
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/17/2018
Last Update Date	:	07/17/2018

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