Provider Demographics
NPI:1619693959
Name:KOBERNUSZ, DANA (FNP-BC)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:KOBERNUSZ
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6411 MINERAL POINT RD STE 200
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705-4342
Mailing Address - Country:US
Mailing Address - Phone:608-230-4479
Mailing Address - Fax:
Practice Address - Street 1:6411 MINERAL POINT RD STE 200
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-4342
Practice Address - Country:US
Practice Address - Phone:608-230-4479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-18
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI13231-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
2022014988OtherANCC BOARD CERTIFICATION