Provider Demographics
NPI:1780179820
Name:WESTBERG, KELLY J (APNP)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:J
Last Name:WESTBERG
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:MRS
Other - First Name:KELLY
Other - Middle Name:J
Other - Last Name:WESTBERG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APNP
Mailing Address - Street 1:2251 N SHORE DR
Mailing Address - Street 2:
Mailing Address - City:RHINELANDER
Mailing Address - State:WI
Mailing Address - Zip Code:54501-6710
Mailing Address - Country:US
Mailing Address - Phone:715-361-4700
Mailing Address - Fax:
Practice Address - Street 1:2251 N SHORE DR
Practice Address - Street 2:
Practice Address - City:RHINELANDER
Practice Address - State:WI
Practice Address - Zip Code:54501
Practice Address - Country:US
Practice Address - Phone:715-361-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-29
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8385-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily