Active NPI
Kimberly D Wiersma, ACNP-BC
- Acute Care Nurse Practitioner
- Lake Forest, IL
National Provider Identifier
1255674016
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Acute Care Nurse Practitioner
- License
- 209004179
- Practice address
- 660 N Westmoreland Rd
Women'S Center, Suite 100
Lake Forest, IL 60045-1659 - Phone
- (847) 582-2134
- Fax
- (847) 535-7285
- NPI assigned
- Mar 30, 2013
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Acute Care Nurse Practitioner | 363LA2100X | 209004179 | IL | Primary |
Addresses
Primary practice location
660 N Westmoreland Rd
Women'S Center, Suite 100
Lake Forest, IL 60045-1659
Mailing address
660 N Westmoreland Rd
Women'S Center, Suite 100
Lake Forest, IL 60045-1659
Phone (847) 582-2134
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 209004179 | IL | MD | Acute Care Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Northwestern Medical Faculty Foundation | Past | Accepting new patients | |
| Central Dupage Physician Group | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
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- Durable Medical Equipment & Medical Supplies
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- NPI 1417718479
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1364601600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1364601600000",
"number": "1255674016",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "660 N WESTMORELAND RD",
"address_2": "WOMEN'S CENTER, SUITE 100",
"city": "LAKE FOREST",
"state": "IL",
"postal_code": "600451659",
"telephone_number": "847-582-2134",
"fax_number": "847-535-7285"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "660 N WESTMORELAND RD",
"address_2": "WOMEN'S CENTER, SUITE 100",
"city": "LAKE FOREST",
"state": "IL",
"postal_code": "600451659",
"telephone_number": "847-582-2134",
"fax_number": "847-535-7285"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WIERSMA",
"first_name": "KIMBERLY",
"middle_name": "D",
"name_prefix": "Ms.",
"credential": "ACNP-BC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-03-30",
"last_updated": "2013-03-30",
"status": "A"
},
"taxonomies": [
{
"code": "363LA2100X",
"taxonomy_group": "",
"desc": "Nurse Practitioner, Acute Care",
"state": "IL",
"license": "209004179",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lake Forest, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.