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General NPI Number Information
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NPI Number | 1952079568
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Entity Type | Individual
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Provider Name | ANDREA JURGILANIS FNP
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Gender | Female
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Dates
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Enumeration Date | 08/31/2021
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Last Update Date | 09/09/2021
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Provider Practice Location Address
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Address Line | 13111 N PORT WASHINGTON RD
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City | MEQUON
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State | WI
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Zip | 53097-2416
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Country | US
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Telephone | 262-243-7300
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Fax |
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Provider Business Mailing Address
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Address Line | 13111 N PORT WASHINGTON RD
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City | MEQUON
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State | WI
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Zip | 53097-2416
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Country | US
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Telephone |
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 176640
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 11299-33
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License Number State | WI
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