Provider Demographics
NPI:1336928290
Name:BURGAM, JOEY LEAVER (DNP, FNP-BC)
Entity Type:Individual
Prefix:
First Name:JOEY
Middle Name:LEAVER
Last Name:BURGAM
Suffix:
Gender:F
Credentials:DNP, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6934 W RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-8863
Mailing Address - Country:US
Mailing Address - Phone:269-365-2300
Mailing Address - Fax:
Practice Address - Street 1:6934 W RIDGE DR
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-8863
Practice Address - Country:US
Practice Address - Phone:269-365-2300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-28
Last Update Date:2023-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704302164363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily