Healthcare Provider Details

I. General information

NPI: 1558465740
Provider Name (Legal Business Name): TANYA RENEE BURNS WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4TH & INNER LOOP
FT IRWIN CA
92310
US

IV. Provider business mailing address

8318A SHILOH ST
FORT IRWIN CA
92310-2421
US

V. Phone/Fax

Practice location:
  • Phone: 760-380-5388
  • Fax:
Mailing address:
  • Phone: 760-386-8122
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number687317
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: