Mariska Cornelia Goebel, DNP, APNP, FNP-C
Individual provider Active NPI Nurse Practitioner · Greendale, WI
NPI 1154933729 · NPPES record last updated Nov 30, 2022
Key facts
- NPI
- 1154933729
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- 10291-33 (WI)
- Practice address
- 6220 W Loomis Rd
Greendale, WI 53129-2448 - Phone
- (414) 423-0555
- NPI assigned
- Aug 17, 2020
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 14
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2020
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Froedtert Andthe Medical College of Wisconsin Community Physicians Inc
Practice addresses (Care Compare)
W168N11237 Western Ave
Germantown, WI 53022-3239
Phone (262) 253-5060
Hospital & facility affiliations
- Froedtert Memorial Lutheran Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20210108001561 | WI | Practitioner - Nurse Practitioner | 1557774601 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 10291-33 | WI | MD | Nurse Practitioner |
| APRN11008277 | FL | MD | Family Nurse Practitioner |
| 209021755 | IL | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Froedtert &the Medical College of Wisconsin Community Physicians, Inc. | Current |
Accepting new patients | |
| Froedtert &the Medical College of Wisconsin Community Physicians, Inc. | Current |
Accepting new patients |
Locations
W168N11237 Western Ave
Germantown, WI 53022
Phone (262) 253-5060
6220 W Loomis Rd
Greendale, WI 53129
Phone (414) 423-0555
N74W12501 Leatherwood Ct
Menomonee Falls, WI 53051
Phone (414) 454-4744
1155 N Mayfair Rd
Wauwatosa, WI 53226
Phone (414) 955-5990
9200 W Wisconsin Ave
Wauwatosa, WI 53226
Phone (414) 259-3000
Interoperability endpoints
- mvandenbergh341307@direct.froedtert.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 209021755 | IL | |
| Family Nurse Practitioner | 363LF0000X | 10291-33 | WI | |
| Family Nurse Practitioner | 363LF0000X | APRN11008277 | FL | |
| Nurse Practitioner | 363L00000X | 10291-33 | WI | Yes |
Addresses
Primary practice location
6220 W Loomis Rd
Greendale, WI 53129-2448
Mailing address
6220 W Loomis Rd
Greendale, WI 53129-2448
Phone (414) 423-0555
Other names
- Mariska Vandenbergh
Other providers in Greendale, WI
- Theresa Gager
- Alfredo Aguilar Garcia
- Anil Kumar Garg
- Dorian Sue Geschke
- Ann Margaret Gieschen-Salazar
- Kathleen Marie Gosenheimer
- William Peter Goulding
- Brian Goyette
- Stephen Gradinjan
- Greendale Chiropractic LLC
All providers in Greendale, WI · Nurse Practitioner in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 30, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.