Individual
LINDSEY JO PROVENZANO BURGESS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
201 E MORRISSEY DR, ELKHORN, WI 53121-4395
(262) 723-6666
Mailing address
201 E MORRISSEY DR, ELKHORN, WI 53121-4395
(262) 723-6666
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
3195
WI
Other
Enumeration date
07/31/2013
Last updated
01/12/2017
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