Provider Demographics
NPI:1295935492
Name:BURMESCH, AMY M (PA)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:M
Last Name:BURMESCH
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:M
Other - Last Name:HAAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:W129N7055 NORTHFIELD DR. BLDG. A, SUITE 203
Mailing Address - Street 2:
Mailing Address - City:MENOMONEE FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53051
Mailing Address - Country:US
Mailing Address - Phone:262-253-7155
Mailing Address - Fax:262-253-7140
Practice Address - Street 1:W129N7055 NORTHFIELD DR. BLDG. A, SUITE 203
Practice Address - Street 2:
Practice Address - City:MENOMONEE FALLS
Practice Address - State:WI
Practice Address - Zip Code:53051
Practice Address - Country:US
Practice Address - Phone:262-253-7155
Practice Address - Fax:262-253-7140
Is Sole Proprietor?:No
Enumeration Date:2007-07-25
Last Update Date:2020-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2147363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant