Kristin Bonilla, RN
Individual provider Active NPI Family Nurse Practitioner · Beaver Dam, WI
NPI 1164317616 · NPPES record last updated Feb 11, 2026
Key facts
- NPI
- 1164317616
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- 17434 (WI)
- Practice address
- 323 York St
Beaver Dam, WI 53916-1725 - Phone
- (920) 344-7010
- NPI assigned
- Jun 12, 2025
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 3
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2025
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Watertown Physician Practices LLC
Practice addresses (Care Compare)
1025 Mulberry St
Lake Mills, WI 53551-1304
Phone (920) 648-4518
Hospital & facility affiliations
- Watertown Memorial 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 |
|---|---|---|---|---|
| I20251219001224 | WI | Practitioner - Nurse Practitioner | 2062907710 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner, Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 17434 | WI | MD | Family Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Watertown Physician Practices LLC | Current |
Accepting new patients | |
| Watertown Physician Practices LLC | Current |
Accepting new patients |
Locations
1025 Mulberry St
Lake Mills, WI 53551
Phone (920) 261-9591
111 Anna St
Waterloo, WI 53594
Phone (920) 478-3776
1507 Doctors Ct
Watertown, WI 53094
Phone (920) 261-4111
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | 17434 | WI | Yes |
Addresses
Primary practice location
323 York St
Beaver Dam, WI 53916-1725
Mailing address
323 York St
Beaver Dam, WI 53916-1725
Phone (920) 344-7010
Other providers in Beaver Dam, WI
- Ronay Bjerke
- Sionag M Black
- Jessica Marie Blatz
- Andrea Michelle Bluel
- Asiedu Boateng
- Scott Robert Borkenhagen
- Dennis Lee Bostwick
- Kristine Braker
- Shelby Ann Brandsma
- Kailin M Brath
All providers in Beaver Dam, WI · Family 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 Feb 11, 2026. 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.