Individual
SUSAN NYSTROM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
855 N WESTHAVEN DR, OSHKOSH, WI 54904-7668
(920) 303-8700
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(800) 326-2250
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
5101017725
MI
207R00000X
Internal Medicine Physician
68879-21
WI
208M00000X
Hospitalist Physician
Primary
68879
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100075784
—
WI
Enumeration date
06/12/2008
Last updated
03/27/2024
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