Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 220376 | AZ |
NPI | 1013480771 |
---|---|
Provider Name | Mr. Matthew S Burrows |
First Address | Peoria, AZ 85381-4246 |
Second Address | Peoria, AZ 85381-4246 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/01/2019 |
Last Update Date | 19/02/2019 |