Healthcare Provider Details

I. General information

NPI: 1457787384
Provider Name (Legal Business Name): JODI C BURANY APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2013
Last Update Date: 11/29/2021
Certification Date: 11/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 W OKLAHOMA AVE 4TH FL
MILWAUKEE WI
53215-4330
US

IV. Provider business mailing address

2900 W OKLAHOMA AVE 4TH FL
MILWAUKEE WI
53215-4330
US

V. Phone/Fax

Practice location:
  • Phone: 414-646-2438
  • Fax: 414-646-5452
Mailing address:
  • Phone: 414-646-2438
  • Fax: 414-646-5452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5504
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: