Individual
KELLY BRANSTROM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
130 2ND ST, NEENAH, WI 54956-2883
(920) 725-2070
Mailing address
855 N WESTHAVEN DR, OSHKOSH, WI 54904-7668
(920) 303-8700
(920) 303-8984
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
171753-30
WI
363L00000X
Nurse Practitioner
Primary
7235-033
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100062155
—
WI
Enumeration date
09/08/2016
Last updated
09/18/2024
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