Imelda N Forsberg, NURSE PRACTITIONER

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

4854-33 Issued in WI

Practice address

6123 Green Bay Rd Ste 120
Kenosha, WI 53142-2927

Phone

(262) 358-2954

NPI assigned

Nov 26, 2007

Last updated

Jun 3, 2026By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in IL, WI2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/2069/brand/1/csg/29/fhir/r4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Optimal Health & Balance LLC

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Kenosha, WI
  • NPI 1255072708
  Medicare reassignment Authorized official
• Lake County Acute Care, LLP

  • Family Medicine Physician
  • Gurnee, IL
  • NPI 1861599052

  Single Specialty

  Medicare reassignment NPD
• Minuteclinic Diagnostic of Illinois PLLC

  • Family Nurse Practitioner
  • Mokena, IL
  • NPI 1356485809

  Single Specialty

  Medicare reassignment NPD
• Kenosha Urgicare

  • Urgent Care Clinic/Center
  • Kenosha, WI
  • NPI 1629373204
  Medicare reassignment
• Lake County Acute Care, LLP

  • Family Medicine Physician
  • Vernon Hills, IL
  • NPI 1053418244
  NPD
• Lake County Acute Care, LLP

  • Family Medicine Physician
  • Buffalo Grove, IL
  • NPI 1720185911
  NPD
• Waukegan Clinic Corp

  • Family Medicine Physician
  • Waukegan, IL
  • NPI 1306937289

  Single Specialty

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1196035200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1780444800000",
    "number": "1306027891",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6123 GREEN BAY RD STE 120",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531422927",
            "telephone_number": "262-358-2954"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6123 GREEN BAY RD STE 120",
            "city": "KENOSHA",
            "state": "WI",
            "postal_code": "531422927",
            "telephone_number": "262-358-2954"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "111 S Washington Ave Ste 202",
            "address_purpose": "LOCATION",
            "city": "Park Ridge",
            "state": "IL",
            "postal_code": "600684293",
            "country_code": "US",
            "telephone_number": "847-423-6800",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3536 52nd St Ste 1B",
            "address_purpose": "LOCATION",
            "city": "Kenosha",
            "state": "WI",
            "postal_code": "531442662",
            "country_code": "US",
            "telephone_number": "262-925-0535",
            "fax_number": "262-925-0538",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FORSBERG",
        "first_name": "IMELDA",
        "middle_name": "N",
        "credential": "NURSE PRACTITIONER",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-11-26",
        "last_updated": "2026-06-03",
        "certification_date": "2026-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "277004152",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WI",
            "license": "4854-33",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "IL",
            "license": "277004152",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "WI",
            "license": "4854-33",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "4854-33",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FULL PRACTICE AUTHORITY FPA",
            "identifier": "277004152",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Foot Factor Podiatry LLC
• Forefront Dermatology, S.C.
• Forefront Dermatology, S.C.
• Forefront Dermatology, S.C.
• Foresight Optical Inc (Kindy Sterling Optical)
• Katarzyna Anna Fortuna-Garcia, PHARMD
• Nora Foshager, M.S., CF-SLP
• Nathaniel Foss, DPT
• Christine Marie Foster, APNP, RN
• Brianna Foti

• Psychiatric/Mental Health Nurse Practitioner in Kenosha, WI
• Providers in Kenosha, WI by specialty
• Psychiatric/Mental Health Nurse Practitioner in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.