MEDICARE: EMMA LEE BIRDEN

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	246ZC0007X	Surgical Assistant	143831

General Provider Information

NPI Number	:	1770446965
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMMA LEE BIRDEN

Provider Business Mailing Address
First Line	:	24634 N 40TH LN
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85310-5109
Country	:	US
Telephone Number	:	480-977-8440
Fax Number	:

Provider Business Practice Location Address
First Line	:	24634 N 40TH LN
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85310-5109
Country	:	US
Telephone Number	:	480-977-8440
Fax Number	:

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

Provider Enumeration Date	:	12/04/2025
Last Update Date	:	12/04/2025

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Directions to “ EMMA LEE BIRDEN ” Practice Location

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