| Doctor Name: | JENNIFER BURGTORF |
| NPI Number: | 1205202025 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | 4704286508 |
| Business Practice Address: | 19135 Allen Rd Suite Number 106 Brownstown Twp, MI - 481836813 |
| Business Phone Number: | 7343629032 |
| Business Fax Number: | |
| Mailing Address: | 6640 Madison St, TAYLOR |
| State: | MI |
| Postal Code: | 481801746 |
| Phone Number: | 7347160148 |
| Fax Number: | |
| NPI Enumeration Date: | 08/16/2015 |
| NPI Last Update Date: | 08/16/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LA2200X |
| License Number: | 4704286508 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MI |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Adult Health |
| Taxonomy Definition: | |