Provider Demographics
NPI:1417465865
Name:BURNS, TRACY LEE (CNM)
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:LEE
Last Name:BURNS
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4842 N BARRANCO DR
Mailing Address - Street 2:
Mailing Address - City:LITCHFIELD PARK
Mailing Address - State:AZ
Mailing Address - Zip Code:85340-2738
Mailing Address - Country:US
Mailing Address - Phone:623-388-4783
Mailing Address - Fax:623-388-4783
Practice Address - Street 1:1170 N ESTRELLA PKWY STE A107
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-9276
Practice Address - Country:US
Practice Address - Phone:623-846-7558
Practice Address - Fax:623-846-1674
Is Sole Proprietor?:No
Enumeration Date:2018-01-19
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP10912367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife