Healthcare Provider Details

I. General information

NPI: 1144570433
Provider Name (Legal Business Name): NINA SEBASTIAN BREDEHORN MSN, APNP, CPNP, PMH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2012
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10303 N PORT WASHINGTON RD SUITE 203
MEQUON WI
53092-5760
US

IV. Provider business mailing address

124 E HARRISON ST
COLUMBUS WI
53925-1510
US

V. Phone/Fax

Practice location:
  • Phone: 262-241-5955
  • Fax: 262-241-5926
Mailing address:
  • Phone: 262-241-5955
  • Fax: 262-241-5926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number170295-30
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number4971-33
License Number StateWI
# 3
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number4971-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: