Provider Demographics
NPI:1386652469
Name:HOLLINGSWORTH-BURDS, LORI K (PA-C)
Entity Type:Individual
Prefix:MS
First Name:LORI
Middle Name:K
Last Name:HOLLINGSWORTH-BURDS
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:9200 W WISCONSIN AVE
Mailing Address - Street 2:DEPARTMENT OF ORTHOPAEDIC SURGERY
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3522
Mailing Address - Country:US
Mailing Address - Phone:414-805-0122
Mailing Address - Fax:414-805-7499
Practice Address - Street 1:9200 W WISCONSIN AVE
Practice Address - Street 2:DEPARTMENT OF ORTHOPAEDIC SURGERY
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3522
Practice Address - Country:US
Practice Address - Phone:414-805-0122
Practice Address - Fax:414-805-7499
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2012-10-26
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Provider Licenses
StateLicense IDTaxonomies
WI2033363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1386652469Medicaid
WI1386652469Medicaid
WI005U 73-601Medicare ID - Type UnspecifiedMILWAUKEE COUNTY
WI42891500Medicare ID - Type UnspecifiedWISCONSIN MEDICAID