Healthcare Provider Details

I. General information

NPI: 1114675493
Provider Name (Legal Business Name): MICHELE LYNNE BURR FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2022
Last Update Date: 07/15/2022
Certification Date: 07/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3507 S MERCY RD STE 101
GILBERT AZ
85297-0441
US

IV. Provider business mailing address

3507 S MERCY RD STE 101
GILBERT AZ
85297-0441
US

V. Phone/Fax

Practice location:
  • Phone: 480-926-0644
  • Fax: 480-926-0645
Mailing address:
  • Phone: 480-926-0644
  • Fax: 480-926-0645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberRN085354
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberTEMP273901
License Number StateAZ
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberAPRN273901
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: