Provider Demographics
NPI:1164095139
Name:FORSTROM, KRISTEN SCOTT (APNP, NP-C)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:SCOTT
Last Name:FORSTROM
Suffix:
Gender:F
Credentials:APNP, NP-C
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:S
Other - Last Name:WEICHBRODT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APNP,NP-C
Mailing Address - Street 1:PO BOX 22487
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54305-2487
Mailing Address - Country:US
Mailing Address - Phone:920-445-7222
Mailing Address - Fax:920-445-7289
Practice Address - Street 1:1711 S STEPHENSON AVE STE 215
Practice Address - Street 2:
Practice Address - City:IRON MOUNTAIN
Practice Address - State:MI
Practice Address - Zip Code:49801-3649
Practice Address - Country:US
Practice Address - Phone:906-828-2576
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-19
Last Update Date:2021-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI11094-33363L00000X
MI4704359564363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
F06211083OtherAMERICAN ACADEMY OF NURSE PRACTITIONERS