Provider Demographics
NPI:1548770712
Name:BURKE, TARA MARIE (NMD)
Entity type:Individual
Prefix:DR
First Name:TARA
Middle Name:MARIE
Last Name:BURKE
Suffix:
Gender:F
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8700 E VISTA BONITA DR STE 200
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-3201
Mailing Address - Country:US
Mailing Address - Phone:480-702-1445
Mailing Address - Fax:833-210-8438
Practice Address - Street 1:8700 E VISTA BONITA DR STE 200
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-3201
Practice Address - Country:US
Practice Address - Phone:480-702-1445
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-02
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ17-1661175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath