Provider Demographics
NPI:1851630834
Name:BORNEMANN, SUZETTE M (APNP)
Entity Type:Individual
Prefix:
First Name:SUZETTE
Middle Name:M
Last Name:BORNEMANN
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:SUZETTE
Other - Middle Name:M
Other - Last Name:KITTELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1866
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54305-1866
Mailing Address - Country:US
Mailing Address - Phone:920-445-7210
Mailing Address - Fax:
Practice Address - Street 1:218 S HWY 141
Practice Address - Street 2:
Practice Address - City:CRIVITZ
Practice Address - State:WI
Practice Address - Zip Code:54114-1677
Practice Address - Country:US
Practice Address - Phone:715-854-7477
Practice Address - Fax:715-854-7785
Is Sole Proprietor?:No
Enumeration Date:2013-02-11
Last Update Date:2022-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5219-33363LC0200X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
2012012365OtherAMERICAN NURSES CREDENTIALING CENTER