Burgoyne, Mary Jo

Burgoyne, Mary Jo is an individual health care provider with primary practice located at 9200 W Wisconsin Ave Suite C-2130, Milwaukee WI 53226-3522. She recently has 2 registered licenses in different health care specialties including Nursing Service Providers / Registered Nurse, Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health. Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health is her primary health care specialty. Burgoyne, Mary Jo can be contacted via phone (414) 805-9990.

Contact Information

Primary practice address
9200 W Wisconsin Ave Suite C-2130 Milwaukee WI 53226-3522
Phone: (414) 805-9990
Fax: (414) 805-0970
Website:
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Health care specialties

SpecialtyCodeLicense #State
Nursing Service Providers / Registered Nurse 163W00000X 66695-030 Wisconsin
Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health 364SP0808X 510-033 Wisconsin

Profile Details

NPI number 1689696007
LBN Legal business name Burgoyne, Mary Jo
Credentials RN, MSN, APNP
Entity Individual
Sole proprietor 1 No
Enumeration date Jul 24th, 2006
Last updated Jun 6th, 2013 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1689696007 NPPES
Wisconsin MEDICAID 40956800

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