MEDICARE: MS. STEPHANIE ANN BURGE APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	110118	NE

General Provider Information

NPI Number	:	1700083953
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. STEPHANIE ANN BURGE APRN

Provider Business Mailing Address
First Line	:	1917 W 24TH ST
Second Line	:	WEST CENTER, 155W
City	:	KEARNEY
State	:	NE
Zip	:	68849-4915
Country	:	US
Telephone Number	:	308-865-8745
Fax Number	:	308-865-8186

Provider Business Practice Location Address
First Line	:	1917 W 24TH ST
Second Line	:	WEST CENTER, 155W
City	:	KEARNEY
State	:	NE
Zip	:	68849-4915
Country	:	US
Telephone Number	:	308-865-8745
Fax Number	:	308-865-8186

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/29/2007
Last Update Date	:	07/08/2007

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