Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | 7959 | NE |
NPI | 1003337098 |
---|---|
Provider Name | Jennifer Marie Burgart |
First Address | Omaha, NE 68124-2353 |
Second Address | Omaha, NE 68124-2353 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2017 |
Last Update Date | 29/06/2017 |