MEDICARE: MRS. DONNA GREEN BURGMAYER CRNP

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	363LA2200X	Adult Health Nurse Practitioner	SP010107	PA

General Provider Information

NPI Number	:	1902046568
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DONNA GREEN BURGMAYER CRNP

Provider Business Mailing Address
First Line	:	1 PENN BOULEVARD
Second Line	:	SUITE 3026
City	:	PHILADELPHIA
State	:	PA
Zip	:	19444-1476
Country	:	US
Telephone Number	:	215-849-7700
Fax Number	:	215-849-7631

Provider Business Practice Location Address
First Line	:	1 PENN BOULEVARD
Second Line	:	SUITE 3026
City	:	PHILADELPHIA
State	:	PA
Zip	:	19444-1476
Country	:	US
Telephone Number	:	215-849-7700
Fax Number	:	215-849-7631

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

Provider Enumeration Date	:	02/23/2009
Last Update Date	:	02/23/2009

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