Healthcare Provider Details

I. General information

NPI: 1588250807
Provider Name (Legal Business Name): BARRY BJORKLUND RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2020
Last Update Date: 12/21/2020
Certification Date: 12/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 N SEGOE RD UNIT 312
MADISON WI
53705-3192
US

IV. Provider business mailing address

625 N SEGOE RD UNIT 312
MADISON WI
53705-3192
US

V. Phone/Fax

Practice location:
  • Phone: 608-712-4562
  • Fax:
Mailing address:
  • Phone: 608-712-4562
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number76481-30
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: