Kimberly Sue Oldenburg, NP

Primary specialty

Primary Care Nurse PractitionerTaxonomy code 363LP2300X

License

4704283424 Issued in MI

Practice address

2300 N Stallman Rd
Suttons Bay, MI 49682-9158

Phone

(231) 534-7200

NPI assigned

Dec 7, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

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 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

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.

• Grand Traverse Band of Ottawa and Chippewa Indians

  • Federally Qualified Health Center (FQHC)
  • Suttons Bay, MI
  • NPI 1134281132
  Medicare reassignment NPD
• Signify Health Medical Associates, PLLC

  • General Practice Physician
  • Dallas, TX
  • NPI 1750845863

  MI

  Medicare reassignment NPD

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

{
    "created_epoch": "1607299200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1708819200000",
    "number": "1659977510",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2300 N STALLMAN RD",
            "city": "SUTTONS BAY",
            "state": "MI",
            "postal_code": "496829158",
            "telephone_number": "231-534-7200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2300 N STALLMAN RD",
            "city": "SUTTONS BAY",
            "state": "MI",
            "postal_code": "496829158",
            "telephone_number": "231-534-7200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OLDENBURG",
        "first_name": "KIMBERLY",
        "middle_name": "SUE",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-12-07",
        "last_updated": "2024-02-25",
        "certification_date": "2024-02-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MI",
            "license": "4704283424",
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "MI",
            "license": "4704283424",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Donald R Mileski, RPH
• Jimmy Mistry, M. D.
• John Allen Nagel, RPH
• Amber G Noble, P.T.
• Theresa O'Boyle, CHW
• Jessica M Paquette, DO
• Abigail Lee Paulson
• Andrew Rummel, D.D.S., M.S.
• Angela Kay Schaub, FNP
• Heather Morgan Sedgwick, FNP-C

• Primary Care Nurse Practitioner in Suttons Bay, MI
• Providers in Suttons Bay, MI by specialty
• Primary Care Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2024; 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.