Healthcare Provider Details

I. General information

NPI: 1811019748
Provider Name (Legal Business Name): BURNS MAXWELL WINTER RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12033 AGENCY RD
PARKER AZ
85344-7718
US

IV. Provider business mailing address

PO BOX 1568
PARKER AZ
85344-1568
US

V. Phone/Fax

Practice location:
  • Phone: 928-669-3270
  • Fax:
Mailing address:
  • Phone: 928-667-5058
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number065501
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: