Matthew Allan Mickelson Valid NPI

Individual provider · Family Nurse Practitioner · Deforest, WI

NPI

1942907647

Type

Individual (Type 1)

Primary specialty

Family Nurse Practitioner (Nurse Practitioner)

Specialty group

Physician Assistants & Advanced Practice Nursing Providers

Taxonomy code

363LF0000X

License number

13661-33 (WI)

Sex

Male

Sole proprietor

No

Enumerated

2023-02-13

Last updated

2023-09-12