Healthcare Provider Details

I. General information

NPI: 1902046568
Provider Name (Legal Business Name): DONNA GREEN BURGMAYER CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2009
Last Update Date: 02/23/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PENN BOULEVARD SUITE 3026
PHILADELPHIA PA
19444-1476
US

IV. Provider business mailing address

1 PENN BOULEVARD SUITE 3026
PHILADELPHIA PA
19444-1476
US

V. Phone/Fax

Practice location:
  • Phone: 215-849-7700
  • Fax: 215-849-7631
Mailing address:
  • Phone: 215-849-7700
  • Fax: 215-849-7631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberSP010107
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: