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Individual

IMELDA N FORSBERG

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
NURSE PRACTITIONER

Contact information

Practice address
6123 GREEN BAY RD STE 120, KENOSHA, WI 53142-2927
(262) 358-2954
Mailing address
6123 GREEN BAY RD STE 120, KENOSHA, WI 53142-2927
(262) 358-2954

Taxonomy

Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
209.006867
IL
363LA2200X
Adult Health Nurse Practitioner
Primary
4854
WI
363LF0000X
Family Nurse Practitioner
277004152
IL
363LF0000X
Family Nurse Practitioner
4854-33
WI
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
277004152
IL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
4854-33
WI
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
PMH08240049
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
277004152
FULL PRACTICE AUTHORITY FPA
IL
01
4854-33
STATE LICENSE
WI
Enumeration date
11/26/2007
Last updated
06/03/2026
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