Individual provider Active NPI

Brenda M Veldboom, NP

  • Nurse Practitioner
  • Random Lake, WI
National Provider Identifier
1992990667
Registry record updated Sep 16, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
3202-033 Issued in WI
Practice address
110 Butler St
Random Lake, WI 53075-1708
Phone
(920) 994-9094
NPI assigned
Sep 6, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 16, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 3202-033 WI Primary

Addresses

Primary practice location

110 Butler St
Random Lake, WI 53075-1708

Mailing address

PO Box 735044
Chicago, IL 60673-5044
Phone (800) 326-2250

Other practice location 1

1001 Service Rd
Kiel, WI 53042-1295
Phone (920) 849-7620

Other identifiers 2

IdentifierTypeStateIssuer
2007004590OtherWIANCC
36042200MedicaidWI

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address bveldboom45038@direct.myadvocateaurora.org Direct
FHIR URL https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20071005000720 WI Practitioner - Nurse Practitioner 0143315069 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2007
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Aurora Medical Group, Inc.Group PAC ID 6709794258, 3,764 clinicians

Practice addresses (Care Compare)

110 Butler St
Random Lake, WI 53075-1708
Phone (920) 994-9094

Hospital & facility affiliations

  • Aurora at Home Home health agency, Green Bay, WI, CCN 527302
  • Aurora Medical Center Hospital, Grafton, WI, CCN 520207

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
3202-033WIMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Aurora Medical Group, Inc. Current Accepting new patients
Aurora Medical Group, Inc. CurrentSince Sep 4, 2007 Accepting new patients
Aurora Medical Group, Inc. CurrentSince Sep 4, 2007 Accepting new patients
Aurora Quick Care, LLC Nurse Practitioner PastSince Jun 28, 2017 Accepting new patients
Aurora Medical Group, Inc. Past Accepting new patients

Locations

313 S Main St
Cedar Grove, WI 53013
Phone (414) 668-8502

1001 Service Rd
Kiel, WI 53042
Phone (920) 894-2636

1020 N 12th St
Milwaukee, WI 53233
Phone (414) 219-3056

110 Butler St
Random Lake, WI 53075
Phone (920) 994-9094

1813 Ashland Ave
Sheboygan, WI 53081
Phone (920) 458-4010

620 S Wisconsin Dr
Sheboygan, WI 53083
Phone (920) 565-4595

2414 Kohler Memorial Dr
Sheboygan, WI 53081
Phone (920) 457-4461

1146 Plankview Green Blvd
Sheboygan Falls, WI 53085
Phone (920) 457-2424

Interoperability endpoints

  • Direct secure messaging: bveldboom45038@direct.myadvocateaurora.org

Organizations & group practices 5

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.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1189036800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1757980800000",
    "number": "1992990667",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 735044",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606735044",
            "telephone_number": "800-326-2250"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "110 BUTLER ST",
            "city": "RANDOM LAKE",
            "state": "WI",
            "postal_code": "530751708",
            "telephone_number": "920-994-9094"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1001 Service Rd",
            "address_purpose": "LOCATION",
            "city": "Kiel",
            "state": "WI",
            "postal_code": "530421295",
            "country_code": "US",
            "telephone_number": "920-849-7620",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "VELDBOOM",
        "first_name": "BRENDA",
        "middle_name": "M",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-09-06",
        "last_updated": "2025-09-16",
        "certification_date": "2025-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WI",
            "license": "3202-033",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANCC",
            "identifier": "2007004590",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "36042200",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "bveldboom45038@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1001 Service Rd",
            "city": "Kiel",
            "state": "WI",
            "country_code": "US",
            "postal_code": "530421295",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "1001 Service Rd",
            "city": "Kiel",
            "state": "WI",
            "country_code": "US",
            "postal_code": "530421295",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Random Lake, WI

Sources for this page

Verify at the official NPI Registry.