Provider Demographics
NPI:1881049948
Name:BURGMAYER, PRISCILLA (CNM)
Entity type:Individual
Prefix:MRS
First Name:PRISCILLA
Middle Name:
Last Name:BURGMAYER
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:841 BUCKBOARD DR
Mailing Address - Street 2:
Mailing Address - City:NEW LENOX
Mailing Address - State:IL
Mailing Address - Zip Code:60451-1337
Mailing Address - Country:US
Mailing Address - Phone:815-269-4344
Mailing Address - Fax:
Practice Address - Street 1:841 BUCKBOARD DR
Practice Address - Street 2:
Practice Address - City:NEW LENOX
Practice Address - State:IL
Practice Address - Zip Code:60451-1337
Practice Address - Country:US
Practice Address - Phone:815-269-4344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-26
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILCNM3054367A00000X
PARN225460L163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse