Healthcare Provider Details

I. General information

NPI: 1023402435
Provider Name (Legal Business Name): JOANNA BURNS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2015
Last Update Date: 03/14/2021
Certification Date: 03/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1035 E JEFFERSON ST
PHOENIX AZ
85034-2295
US

IV. Provider business mailing address

26506 S 196TH WAY
QUEEN CREEK AZ
85142
US

V. Phone/Fax

Practice location:
  • Phone: 602-251-0650
  • Fax:
Mailing address:
  • Phone: 480-840-4067
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP7568
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP7568
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: