Individual
IMELDA N FORSBERG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
NURSE PRACTITIONER
Contact information
Practice address
6430 GREENBAY RD, SUITE 104, KENOSHA, WI 53142-2948
(262) 925-0535
(262) 925-0538
Mailing address
6925 184TH AVENUE, BRISTOL, WI 53104
(262) 948-1890
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
209.006867
IL
363LA2200X
Adult Health Nurse Practitioner
Primary
4854
WI
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
PMH08240049
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4854-33
STATE LICENSE
WI
Enumeration date
11/26/2007
Last updated
02/07/2025
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