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General NPI Number Information
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NPI Number | 1538440862
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Entity Type | Individual
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Provider Name | JILL ANNE BURGHOLZER CRNP-PMH
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Gender | Female
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Dates
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Enumeration Date | 08/31/2011
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Last Update Date | 09/03/2021
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Provider Practice Location Address
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Address Line | 112 SAINT CLAIRE PL STE 202
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City | STEVENSVILLE
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State | MD
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Zip | 21666-2193
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Country | US
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Telephone | 410-200-6920
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Fax |
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Provider Business Mailing Address
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Address Line | 112 SAINT CLAIRE PL STE 202
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City | STEVENSVILLE
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State | MD
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Zip | 21666-2193
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Country | US
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Telephone | 410-200-6920
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | R181825
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 0024176704
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 1050971
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License Number State | DC
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