Healthcare Provider Details

I. General information

NPI: 1841271566
Provider Name (Legal Business Name): GLENDA SUE SUNDBERG FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2005
Last Update Date: 01/22/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 W KK RIVER PKWY SUITE 250
MILWAUKEE WI
53215-3669
US

IV. Provider business mailing address

PO BOX 735044
CHICAGO IL
60673-5044
US

V. Phone/Fax

Practice location:
  • Phone: 414-649-6732
  • Fax: 414-649-5840
Mailing address:
  • Phone: 800-326-2250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number696
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number107882-030
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: