Healthcare Provider Details

I. General information

NPI: 1740263128
Provider Name (Legal Business Name): IRENE MARILYN AMUNDSEN RN BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: IRENE MARILYN PISCHNER RN BSN

II. Dates (important events)

Enumeration Date: 11/21/2005
Last Update Date: 07/13/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

W7201 COUNTY ROAD C
BURNETT WI
53922-9779
US

IV. Provider business mailing address

W7201 COUNTY ROAD C
BURNETT WI
53922-9779
US

V. Phone/Fax

Practice location:
  • Phone: 920-324-3801
  • Fax:
Mailing address:
  • Phone: 920-324-3801
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number52614030
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: