Healthcare Provider Details

I. General information

NPI: 1528977865
Provider Name (Legal Business Name): KELSEY AILEEN BJORNSON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/03/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4855 S MOORLAND RD FL 3
NEW BERLIN WI
53151-7494
US

IV. Provider business mailing address

172 E PINE HOLLOW LN APT 4
OAK CREEK WI
53154-7715
US

V. Phone/Fax

Practice location:
  • Phone: 262-432-7599
  • Fax: 262-432-7694
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number19068-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: