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General NPI Number Information
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NPI Number | 1477565943
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Entity Type | Individual
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Provider Name | PENNY BURKERT P.A.-C.
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Gender | Female
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Dates
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Enumeration Date | 08/13/2006
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Last Update Date | 12/28/2010
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Provider Practice Location Address
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Address Line | 6655 S RURAL RD SUITE 3
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City | TEMPE
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State | AZ
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Zip | 85283-3793
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Country | US
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Telephone | 480-831-0600
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Fax | 480-820-3065
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Provider Business Mailing Address
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Address Line | 6655 S RURAL RD SUITE 3
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City | TEMPE
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State | AZ
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Zip | 85283-3793
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Country | US
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Telephone | 480-831-0600
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Fax | 480-820-3065
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 1492
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License Number State | AZ
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