MEDICARE: SHARON MARIE BURNS CRNA

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	163W00000X	Registered Nurse	RN040308	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	36750000X	OTHER	AZ	NURSE ANESTHETIST-CERTIFIED REGISTERED AZ

General Provider Information

NPI Number	:	1922126556
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHARON MARIE BURNS CRNA

Provider Business Mailing Address
First Line	:	22430 N 53RD ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85054-7114
Country	:	US
Telephone Number	:	480-451-1679
Fax Number	:

Provider Business Practice Location Address
First Line	:	22430 N 53RD ST
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85054-7114
Country	:	US
Telephone Number	:	480-451-1679
Fax Number	:

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

Provider Enumeration Date	:	03/26/2007
Last Update Date	:	10/08/2009

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