Individual
MARY JO BURGOYNE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, MSN, APNP
Contact information
Practice address
9200 W WISCONSIN AVE, SUITE C-2130, MILWAUKEE, WI 53226-3522
(414) 805-9990
(414) 805-0970
Mailing address
1522 N PROSPECT AVE, SUITE 1006, MILWAUKEE, WI 53202-6512
(414) 916-4476
(414) 805-0970
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
66695-030
WI
364SP0808X
Psychiatric/Mental Health Clinical Nurse Specialist
Primary
510-033
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40956800
—
WI
Enumeration date
07/24/2006
Last updated
06/06/2013
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