MEDICARE: JILL ANNE BURGHOLZER CRNP-PMH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	R181825	MD
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	0024176704	VA
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	1050971	DC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	R968	OTHER	MD	CAREFIRST NATIONAL
2	522156095	OTHER	MD	COMMERCIAL
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	LM49EA	OTHER	MD	CAREFIRST BCBS-LOCAL

General Provider Information

NPI Number	:	1538440862
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JILL ANNE BURGHOLZER CRNP-PMH

Provider Business Mailing Address
First Line	:	112 SAINT CLAIRE PL STE 202
Second Line	:
City	:	STEVENSVILLE
State	:	MD
Zip	:	21666-2193
Country	:	US
Telephone Number	:	410-200-6920
Fax Number	:

Provider Business Practice Location Address
First Line	:	112 SAINT CLAIRE PL STE 202
Second Line	:
City	:	STEVENSVILLE
State	:	MD
Zip	:	21666-2193
Country	:	US
Telephone Number	:	410-200-6920
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2011
Last Update Date	:	09/03/2021

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Directions to “ JILL ANNE BURGHOLZER CRNP-PMH” Practice Location

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