Forsberg, Imelda N

Forsberg, Imelda N is an sole proprietor health care provider with primary practice located at 6123 Green Bay Rd Ste 120 , Kenosha WI 53142-2927. She recently has 2 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Family, Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health. Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health is her primary health care specialty. Forsberg, Imelda N can be contacted via phone (262) 358-2954.

Contact Information

Primary practice address
6123 Green Bay Rd Ste 120 Kenosha WI 53142-2927
Phone: (262) 358-2954
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 277004152 Illinois
Physician Assistants & Advanced Practice Nursing Providers / Family 363LF0000X 4854-33 Wisconsin
Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health 363LP0808X 277004152 Illinois
Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health 363LP0808X 4854-33 Wisconsin

Profile Details

NPI number 1306027891
LBN Legal business name Forsberg, Imelda N
Credentials NURSE PRACTITIONER
Entity Individual
Sole proprietor 1 Yes
Enumeration date Nov 26th, 2007
Last updated Jun 3rd, 2026 - about 4 months ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1306027891 NPPES
Illinois Other 277004152 FULL PRACTICE AUTHORITY FPA
Illinois Other 4854-33 FULL PRACTICE AUTHORITY FPA

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