Doctor Name: | JENNIFER J BURGOS |
NPI Number: | 1770711863 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | FNP |
License Number: | R164473-7 |
Business Practice Address: | 200 Bunker Hill Dr Aitkin, MN - 564311865 |
Business Phone Number: | 2189272157 |
Business Fax Number: | 2189274130 |
Mailing Address: | 200 Bunker Hill Dr, AITKIN |
State: | MN |
Postal Code: | 564311865 |
Phone Number: | 2189272157 |
Fax Number: | 2189274130 |
NPI Enumeration Date: | 06/26/2009 |
NPI Last Update Date: | 04/17/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | R164473-7 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MN |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |