Provider Demographics
NPI:1487328142
Name:BURNELL, TRICIA A (MSN, APNP, FNP-C)
Entity type:Individual
Prefix:
First Name:TRICIA
Middle Name:A
Last Name:BURNELL
Suffix:
Gender:F
Credentials:MSN, APNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3187 ECLIPSE DR
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54311-4995
Mailing Address - Country:US
Mailing Address - Phone:920-265-6355
Mailing Address - Fax:
Practice Address - Street 1:777 ALGOMA BLVD
Practice Address - Street 2:
Practice Address - City:OSHKOSH
Practice Address - State:WI
Practice Address - Zip Code:54901-3534
Practice Address - Country:US
Practice Address - Phone:920-424-2424
Practice Address - Fax:920-424-1769
Is Sole Proprietor?:No
Enumeration Date:2021-08-05
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11152-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI11152-33OtherAPNP