Healthcare Provider Details

I. General information

NPI: 1750787339
Provider Name (Legal Business Name): TAMARA S BURRIS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/10/2014
Last Update Date: 11/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 E 32ND ST
SILVER CITY NM
88061-7287
US

IV. Provider business mailing address

1600 E 32ND ST
SILVER CITY NM
88061-7287
US

V. Phone/Fax

Practice location:
  • Phone: 575-538-2981
  • Fax: 575-388-3373
Mailing address:
  • Phone: 575-538-2981
  • Fax: 575-388-3373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCNP-02540
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: