Provider Demographics
NPI:1982038659
Name:BURT, MARJORIE ANN (RN)
Entity Type:Individual
Prefix:MISS
First Name:MARJORIE
Middle Name:ANN
Last Name:BURT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9220 W LOCKLAND CT
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-3717
Mailing Address - Country:US
Mailing Address - Phone:602-525-3874
Mailing Address - Fax:
Practice Address - Street 1:9220 W LOCKLAND CT
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-3717
Practice Address - Country:US
Practice Address - Phone:602-525-3874
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-29
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN032463163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse