Individual ProviderKelly BranstromNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address130 2nd St, Neenah, WI 54956-2883(920) 725-2070(920) 303-8700PECOS EnrollmentBased on the most recent information from CMS, provider Kelly Branstrom is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records yesterday at 12:57 PM.Profile DetailsProvider ID1497202303Provider TypeIndividualFull NameBranstrom, KellyCredentialNPGenderFemaleSole ProprietorNoEnumeration Date9/8/2016Last Updated9/18/2024Contact InformationPractice LocationPractice Address130 2nd St, Neenah, WI 54956-2883Phone(920) 725-2070FaxUnlisted FaxMailing LocationMailing Address855 N Westhaven Dr, Oshkosh, WI 54904-7668Phone(920) 303-8700Fax(920) 303-8984Provider TaxonomiesCodeDescriptionLicenseCode363L00000XPrimaryDescriptionNurse PractitionerPhysician Assistants & Advanced Practice Nursing ProvidersLicense7235-033WisconsinCode163W00000XDescriptionRegistered NurseNursing Service ProvidersLicense171753-30WisconsinProvider IdentifiersIDDescriptionIssuerID100062155DescriptionMedicaidIssuerUnlistedWisconsin