Provider Demographics
NPI:1649744558
Name:BURG, MEGAN (MSN, APNP, FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:
Last Name:BURG
Suffix:
Gender:F
Credentials:MSN, APNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W5724 BONNER LN
Mailing Address - Street 2:
Mailing Address - City:WALWORTH
Mailing Address - State:WI
Mailing Address - Zip Code:53184-5951
Mailing Address - Country:US
Mailing Address - Phone:262-374-1779
Mailing Address - Fax:
Practice Address - Street 1:201 E MORRISSEY DR
Practice Address - Street 2:
Practice Address - City:ELKHORN
Practice Address - State:WI
Practice Address - Zip Code:53121-4395
Practice Address - Country:US
Practice Address - Phone:262-723-3100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-14
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8904363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100085709Medicaid