MEDICARE: DANA KOBERNUSZ FNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	13231	WI
2	363LF0000X	Family Nurse Practitioner	13231-33	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2022014988	OTHER		ANCC BOARD CERTIFICATION

General Provider Information

NPI Number	:	1619693959
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANA KOBERNUSZ FNP-BC

Provider Business Mailing Address
First Line	:	6411 MINERAL POINT RD STE 200
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53705-4342
Country	:	US
Telephone Number	:	608-230-4479
Fax Number	:

Provider Business Practice Location Address
First Line	:	6411 MINERAL POINT RD STE 200
Second Line	:
City	:	MADISON
State	:	WI
Zip	:	53705-4342
Country	:	US
Telephone Number	:	608-230-4479
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/18/2022
Last Update Date	:	12/24/2025

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