Provider Demographics
NPI:1831766633
Name:MY NURSE DOC CG PLLC
Entity type:Organization
Organization Name:MY NURSE DOC CG PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:BURTON
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:520-836-0666
Mailing Address - Street 1:609 W COTTONWOOD LN STE 3
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85122-2248
Mailing Address - Country:US
Mailing Address - Phone:520-836-0666
Mailing Address - Fax:520-836-9273
Practice Address - Street 1:609 W COTTONWOOD LN STE 3
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-2248
Practice Address - Country:US
Practice Address - Phone:520-836-0666
Practice Address - Fax:520-836-9273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-09
Last Update Date:2023-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care