Healthcare Provider Details

I. General information

NPI: 1891395109
Provider Name (Legal Business Name): JOY BERGER ZGANJAR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2020
Last Update Date: 01/21/2021
Certification Date: 01/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

S69W15636 JANESVILLE RD
MUSKEGO WI
53150-9330
US

IV. Provider business mailing address

7355 S 39TH CT
FRANKLIN WI
53132-8307
US

V. Phone/Fax

Practice location:
  • Phone: 262-928-7000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9850
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number9850
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: