Provider Demographics
NPI:1578984936
Name:BURRIS, DONNAMARIE (AGACNP -BC)
Entity Type:Individual
Prefix:MS
First Name:DONNAMARIE
Middle Name:
Last Name:BURRIS
Suffix:
Gender:F
Credentials:AGACNP -BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5859 W TALAVI BLVD
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-1869
Mailing Address - Country:US
Mailing Address - Phone:602-298-7777
Mailing Address - Fax:
Practice Address - Street 1:5859 W TALAVI BLVD
Practice Address - Street 2:STE 100
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-1870
Practice Address - Country:US
Practice Address - Phone:602-298-7777
Practice Address - Fax:623-930-6060
Is Sole Proprietor?:No
Enumeration Date:2014-01-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.15390-NP363LF0000X
AZAP9983363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ212194OtherMEDICARE PTAN
AZZ201835OtherMEDICARE PTAN
AZ272578Medicaid