Healthcare Provider Details

I. General information

NPI: 1225862188
Provider Name (Legal Business Name): VICTORIA BURTON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2024
Last Update Date: 08/31/2024
Certification Date: 08/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1621 W WILDWOOD DR
PHOENIX AZ
85045-1727
US

IV. Provider business mailing address

1621 W WILDWOOD DR
PHOENIX AZ
85045-1727
US

V. Phone/Fax

Practice location:
  • Phone: 480-352-6098
  • Fax:
Mailing address:
  • Phone: 480-352-6098
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0002X
TaxonomyHigh-Risk Obstetric Registered Nurse
License Number303011
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: