Provider Demographics
NPI:1144570433
Name:BREDEHORN, NINA SEBASTIAN (MSN, APNP, CPNP, PMH)
Entity Type:Individual
Prefix:
First Name:NINA
Middle Name:SEBASTIAN
Last Name:BREDEHORN
Suffix:
Gender:F
Credentials:MSN, APNP, CPNP, PMH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 E HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:WI
Mailing Address - Zip Code:53925-1510
Mailing Address - Country:US
Mailing Address - Phone:262-241-5955
Mailing Address - Fax:262-241-5926
Practice Address - Street 1:10303 N PORT WASHINGTON RD
Practice Address - Street 2:SUITE 203
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092-5760
Practice Address - Country:US
Practice Address - Phone:262-241-5955
Practice Address - Fax:262-241-5926
Is Sole Proprietor?:No
Enumeration Date:2012-09-13
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI170295-30163WP0808X
WI4971-33363LP0808X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health