Provider Demographics
NPI:1295253896
Name:BUREK, KATHLEEN ANGELA (RN)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:ANGELA
Last Name:BUREK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 ASPEN GROVE LN
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54403-9384
Mailing Address - Country:US
Mailing Address - Phone:918-810-3469
Mailing Address - Fax:
Practice Address - Street 1:916 S 10TH ST
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54403-6502
Practice Address - Country:US
Practice Address - Phone:715-842-3138
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-02
Last Update Date:2017-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI151688163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty