Provider Demographics
NPI:1083059034
Name:BRZEZINSKI, MEGAN C (APNP)
Entity Type:Individual
Prefix:
First Name:MEGAN
Middle Name:C
Last Name:BRZEZINSKI
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:MEGAN
Other - Middle Name:C
Other - Last Name:MCGOVERN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 22487
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54305-2487
Mailing Address - Country:US
Mailing Address - Phone:920-592-9475
Mailing Address - Fax:
Practice Address - Street 1:725 S WEBSTER AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:GREEN BAY
Practice Address - State:WI
Practice Address - Zip Code:54301-3500
Practice Address - Country:US
Practice Address - Phone:920-430-7100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-03
Last Update Date:2015-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI175304-30163W00000X
WI5339-33363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI078450071Medicare Oscar/Certification
WIK400266099Medicare Oscar/Certification
WIK400113406Medicare Oscar/Certification
WIK400092001Medicare Oscar/Certification