MEDICARE: ADRIENNE BURKE MILLER CNM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LX0001X	Obstetrics & Gynecology Nurse Practitioner	222582	AZ
2	363LX0001X	Obstetrics & Gynecology Nurse Practitioner	RN131036	AZ

General Provider Information

NPI Number	:	1285197517
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADRIENNE BURKE MILLER CNM

Provider Business Mailing Address
First Line	:	1661 E CEMELBACK ROAD
Second Line	:	SUITE 200
City	:	PHOENIX
State	:	AZ
Zip	:	85016-3913
Country	:	US
Telephone Number	:	602-422-9000
Fax Number	:	602-556-5951

Provider Business Practice Location Address
First Line	:	22711 S. ELLSWORTH ROAD
Second Line	:	SUITE 104
City	:	QUEEN CREEK
State	:	AZ
Zip	:	85142-6789
Country	:	US
Telephone Number	:	480-782-0993
Fax Number	:	833-337-0386

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/12/2019
Last Update Date	:	10/06/2022

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