Suzette M Bornemann, APNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

5219-33 Issued in WI

Practice address

218 S Hwy 141
Crivitz, WI 54114-1677

Phone

(715) 854-7477

Fax

(715) 854-7785

NPI assigned

Feb 11, 2013

Last updated

Dec 7, 2022By the provider in NPPES

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

Other identifiers 1

Other names 1

• Suzette M Kittelson Former name

Medicare fee-for-service enrollment

Enrolled in WI

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Bellin Memorial Hospital Inc

  dba Bellin Health Algoma

  • Rural Health Clinic/Center
  • Algoma, WI
  • NPI 1609838473
  Medicare reassignment NPD
• Bellin Memorial Hospital Inc

  dba FMC Seymour

  • Family Medicine Physician
  • Seymour, WI
  • NPI 1033171723
  NPD
• Bellin Memorial Hospital Inc

  dba Bellin Health

  • Family Medicine Physician
  • Green Bay, WI
  • NPI 1033172390
  NPD
• Prevea Clinic, Inc.

  • Internal Medicine Physician
  • Green Bay, WI
  • NPI 1306869276
  NPD (past)

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

{
    "created_epoch": "1360540800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1670371200000",
    "number": "1851630834",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1866",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543051866",
            "telephone_number": "920-445-7210"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "218 S HWY 141",
            "city": "CRIVITZ",
            "state": "WI",
            "postal_code": "541141677",
            "telephone_number": "715-854-7477",
            "fax_number": "715-854-7785"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3021 Voyager Dr",
            "address_purpose": "LOCATION",
            "city": "Green Bay",
            "state": "WI",
            "postal_code": "543118303",
            "country_code": "US",
            "telephone_number": "920-496-1700",
            "fax_number": "920-496-4705",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "2820 Roosevelt Rd",
            "address_purpose": "LOCATION",
            "city": "Marinette",
            "state": "WI",
            "postal_code": "541433834",
            "country_code": "US",
            "telephone_number": "715-735-5225",
            "fax_number": "715-735-5388",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "307 Manor Dr",
            "address_purpose": "LOCATION",
            "city": "Suring",
            "state": "WI",
            "postal_code": "541749182",
            "country_code": "US",
            "telephone_number": "920-842-2144",
            "fax_number": "920-842-4111",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "441 French St",
            "address_purpose": "LOCATION",
            "city": "Peshtigo",
            "state": "WI",
            "postal_code": "541571203",
            "country_code": "US",
            "telephone_number": "715-582-9949",
            "fax_number": "715-582-4464",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "15481 Commercial Rd Ste E",
            "address_purpose": "LOCATION",
            "city": "Lakewood",
            "state": "WI",
            "postal_code": "541389677",
            "country_code": "US",
            "telephone_number": "715-276-9048",
            "fax_number": "715-276-2849",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "401 W Mill St",
            "address_purpose": "LOCATION",
            "city": "Bonduel",
            "state": "WI",
            "postal_code": "541079246",
            "country_code": "US",
            "telephone_number": "715-758-2167",
            "fax_number": "715-758-6701",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "723 S Wisconsin St",
            "address_purpose": "LOCATION",
            "city": "Pulaski",
            "state": "WI",
            "postal_code": "541629303",
            "country_code": "US",
            "telephone_number": "820-822-1100",
            "fax_number": "920-822-5731",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "405 Commercial St",
            "address_purpose": "LOCATION",
            "city": "Seymour",
            "state": "WI",
            "postal_code": "541658474",
            "country_code": "US",
            "telephone_number": "920-833-2318",
            "fax_number": "920-833-6883",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BORNEMANN",
        "first_name": "SUZETTE",
        "middle_name": "M",
        "credential": "APNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-02-11",
        "last_updated": "2022-12-07",
        "certification_date": "2022-12-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LC0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Critical Care Medicine",
            "state": "WI",
            "license": "5219-33",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WI",
            "license": "5219-33",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERICAN NURSES CREDENTIALING CENTER",
            "identifier": "2012012365",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "SUZETTE",
            "last_name": "KITTELSON",
            "middle_name": "M",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Abigail Rae Barley
• Bellin Memorial Hospital Inc (Bellin Health Crivitz Specialty Clinic)
• Meghan Rose Berken, PHARMD
• Brianna Blanck-Grott, D.C.
• Kellen Blanck-Grott, D.C.
• Amanda Kay Bruins, COTA
• Jessica Bucksa, PHARMD
• Cheryl Lou Buechler, LPN
• Crivitz Medical Center
• Peter Curio, M.D.

• Family Nurse Practitioner in Crivitz, WI
• Providers in Crivitz, WI by specialty
• Family Nurse Practitioner in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2022; 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.