Provider Demographics
NPI:1982750709
Name:BURGER, MICHELLE R (CPNP)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:R
Last Name:BURGER
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12150 E 96TH ST N STE 101
Mailing Address - Street 2:
Mailing Address - City:OWASSO
Mailing Address - State:OK
Mailing Address - Zip Code:74055-5339
Mailing Address - Country:US
Mailing Address - Phone:918-716-5437
Mailing Address - Fax:
Practice Address - Street 1:12150 E 96TH ST N STE 101
Practice Address - Street 2:
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-5339
Practice Address - Country:US
Practice Address - Phone:918-716-5437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2025-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0048215363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1450693Medicaid