Provider Demographics
NPI:1891849733
Name:BURKE, THOMASINA JEAN (RN)
Entity type:Individual
Prefix:MRS
First Name:THOMASINA
Middle Name:JEAN
Last Name:BURKE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MISS
Other - First Name:THOMASINA
Other - Middle Name:JEAN
Other - Last Name:MADDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSN
Mailing Address - Street 1:6045 E ROSE CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-6715
Mailing Address - Country:US
Mailing Address - Phone:480-484-6811
Mailing Address - Fax:480-484-6801
Practice Address - Street 1:2501 N 74TH ST
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85257-1502
Practice Address - Country:US
Practice Address - Phone:480-484-6800
Practice Address - Fax:480-484-6801
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN079618163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ626187OtherAHCCCS