Provider Demographics
NPI:1790723120
Name:BURGARD, LISA R (FNP)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:R
Last Name:BURGARD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 S NEW BALLAS RD
Mailing Address - Street 2:498A
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-8232
Mailing Address - Country:US
Mailing Address - Phone:314-251-3376
Mailing Address - Fax:314-251-5781
Practice Address - Street 1:621 S NEW BALLAS RD
Practice Address - Street 2:498A
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8232
Practice Address - Country:US
Practice Address - Phone:314-251-3376
Practice Address - Fax:314-251-5781
Is Sole Proprietor?:No
Enumeration Date:2006-06-04
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO129049363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO000081641Medicare ID - Type UnspecifiedMEDICARE ID NUMBER
MOP93516`Medicare UPIN