Provider Demographics
NPI:1609231943
Name:BURGESS, JENA (BSN, MSN, CNP)
Entity Type:Individual
Prefix:
First Name:JENA
Middle Name:
Last Name:BURGESS
Suffix:
Gender:F
Credentials:BSN, MSN, CNP
Other - Prefix:
Other - First Name:JENA
Other - Middle Name:
Other - Last Name:WENANDE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSN, MSN, CNP
Mailing Address - Street 1:201 N FANELLE AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57103-1126
Mailing Address - Country:US
Mailing Address - Phone:605-999-6893
Mailing Address - Fax:
Practice Address - Street 1:1417 S CLIFF AVE STE 300
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-1062
Practice Address - Country:US
Practice Address - Phone:605-322-8630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-30
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCP001020363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily