Provider Demographics
NPI:1861058810
Name:BURNETTE, RITA MARIE
Entity type:Individual
Prefix:
First Name:RITA
Middle Name:MARIE
Last Name:BURNETTE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 E BROWN RD STE 204
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85201-3544
Mailing Address - Country:US
Mailing Address - Phone:480-459-6820
Mailing Address - Fax:866-663-0318
Practice Address - Street 1:323 E BROWN RD STE 204
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201-3544
Practice Address - Country:US
Practice Address - Phone:480-459-6820
Practice Address - Fax:866-663-0318
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-15
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZC001744332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies