Healthcare Provider Details

I. General information

NPI: 1881749638
Provider Name (Legal Business Name): MRS. KIMBERLY ANN BURNHAM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIMBERLY BURNHAM RN

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 E ELLIOT RD
GILBERT AZ
85234-1304
US

IV. Provider business mailing address

2550 E ELLIOT RD
GILBERT AZ
85234-1304
US

V. Phone/Fax

Practice location:
  • Phone: 480-892-2801
  • Fax: 480-926-3673
Mailing address:
  • Phone: 480-892-2801
  • Fax: 480-926-3673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License NumberRN076435
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: