MEDICARE: JORDAN DEAN BURNETT PMHNP

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	18063-33	WI

General Provider Information

NPI Number	:	1669326377
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JORDAN DEAN BURNETT PMHNP

Provider Business Mailing Address
First Line	:	790 N MILWAUKEE ST STE 302
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53202-4073
Country	:	US
Telephone Number	:	414-248-0906
Fax Number	:

Provider Business Practice Location Address
First Line	:	790 N MILWAUKEE ST STE 302
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53202-4073
Country	:	US
Telephone Number	:	414-248-0090
Fax Number	:	414-248-0090

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

Provider Enumeration Date	:	02/21/2026
Last Update Date	:	02/21/2026

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