Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | A159890 | CA |
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | 60971 | AZ |
NPI | 1417375882 |
---|---|
Provider Name | Jessica Davis Burns |
First Address | Phoenix, AZ 85018-2327 |
Second Address | Phoenix, AZ 85016-7710 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/04/2014 |
Last Update Date | 10/12/2020 |