Provider Demographics
NPI:1568884096
Name:BURKE, CODY (CRNA)
Entity Type:Individual
Prefix:MR
First Name:CODY
Middle Name:
Last Name:BURKE
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2158 N GILBERT RD STE 101
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85203-2109
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2248 N ALMA SCHOOL RD STE 104
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-2488
Practice Address - Country:US
Practice Address - Phone:520-322-8361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-17
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX765794367500000X
COC-APN.0000720-C-CRNA367500000X
NMAPRN-CRNA-54037367500000X
MTAPRN-196442367500000X
OR201903465-CRNA367500000X
AZ2599441367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered