Provider Demographics
NPI:1336683077
Name:BURROWS LOCUM TENENS NP, PLLC
Entity Type:Organization
Organization Name:BURROWS LOCUM TENENS NP, PLLC
Other - Org Name:AGE LESS WELLNESS AND AESTHETICS CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/FNP
Authorized Official - Prefix:MS
Authorized Official - First Name:MARGO
Authorized Official - Middle Name:MAE
Authorized Official - Last Name:BURROWS
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:307-421-3694
Mailing Address - Street 1:3303 S. LINDSAY RD, SUTIE 119A
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-2100
Mailing Address - Country:US
Mailing Address - Phone:480-787-2555
Mailing Address - Fax:480-900-2041
Practice Address - Street 1:3303 S LINDSAY RD STE 119A
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85297-2100
Practice Address - Country:US
Practice Address - Phone:480-787-2555
Practice Address - Fax:480-900-2041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-15
Last Update Date:2017-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service