Healthcare Provider Details

I. General information

NPI: 1770446965
Provider Name (Legal Business Name): EMMA LEE BIRDEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2025
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24634 N 40TH LN
GLENDALE AZ
85310-5109
US

IV. Provider business mailing address

24634 N 40TH LN
GLENDALE AZ
85310-5109
US

V. Phone/Fax

Practice location:
  • Phone: 480-977-8440
  • Fax:
Mailing address:
  • Phone: 480-977-8440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number143831
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: