Provider Demographics
NPI:1508938937
Name:BURGERT, GRACE ANNE (MS)
Entity Type:Individual
Prefix:MRS
First Name:GRACE
Middle Name:ANNE
Last Name:BURGERT
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 2ND ST
Mailing Address - Street 2:
Mailing Address - City:JULIAN
Mailing Address - State:NE
Mailing Address - Zip Code:68379
Mailing Address - Country:US
Mailing Address - Phone:402-242-2461
Mailing Address - Fax:402-242-2461
Practice Address - Street 1:1903 4TH CORSO
Practice Address - Street 2:
Practice Address - City:NEBRASKA CITY
Practice Address - State:NE
Practice Address - Zip Code:68410
Practice Address - Country:US
Practice Address - Phone:402-873-5505
Practice Address - Fax:402-873-6374
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47052851595Medicaid