Healthcare Provider Details

I. General information

NPI: 1083059034
Provider Name (Legal Business Name): MEGAN C BRZEZINSKI APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MEGAN C MCGOVERN RN

II. Dates (important events)

Enumeration Date: 05/03/2013
Last Update Date: 12/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 S WEBSTER AVE SUITE 201
GREEN BAY WI
54301-3500
US

IV. Provider business mailing address

PO BOX 22487
GREEN BAY WI
54305-2487
US

V. Phone/Fax

Practice location:
  • Phone: 920-430-7100
  • Fax:
Mailing address:
  • Phone: 920-592-9475
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5339-33
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number175304-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: