Healthcare Provider Details

I. General information

NPI: 1700731452
Provider Name (Legal Business Name): IVY SUE BIELEFELDT FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2026
Last Update Date: 02/27/2026
Certification Date: 02/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

S890 LARSON RD
MONDOVI WI
54755-8372
US

IV. Provider business mailing address

S890 LARSON RD
MONDOVI WI
54755-8372
US

V. Phone/Fax

Practice location:
  • Phone: 715-523-1792
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number18073
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: