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NPI Code Detail

MEDICARE: MRS. LISA NICOLE BURGIN FNP-C

MEDICARE:  MRS. LISA NICOLE BURGIN  FNP-C
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
1363LF0000XFamily Nurse PractitionerAP7960AZ

General Provider Information

NPI Number : 1679949846
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. LISA NICOLE BURGIN FNP-C
Provider Business Mailing Address
First Line : 2620 ELM HILL PIKE
Second Line :
City : NASHVILLE
State : TN
Zip : 37214-3108
Country : US
Telephone Number : 615-425-4200
Fax Number :
Provider Business Practice Location Address
First Line : 6470 S HIGLEY RD
Second Line :
City : GILBERT
State : AZ
Zip : 85298-4341
Country : US
Telephone Number : 480-809-2409
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/11/2015
Last Update Date : 08/11/2015

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Directions to “ MRS. LISA NICOLE BURGIN FNP-C” Practice Location

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