Individual provider · Type 1 NPI

Matthew Allan Mickelson

Family Nurse Practitioner · Deforest, WI

NPI number 1942907647 Active

Practice location

4200 Savannah Dr
Deforest, WI 53532-2909

Mailing address

202 S Park St
Madison, WI 53715-1507

Specialties and licenses

TaxonomyCodeLicense
Registered Nurse 163W00000X241314 (WI)
Family Nurse Practitioner Primary 363LF0000X13661-33 (WI)

Family Nurse Practitioner: Definition to come...

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About NPI 1942907647

Matthew Allan Mickelson's National Provider Identifier is 1942907647, issued on Feb 13, 2023. The primary taxonomy on file is Family Nurse Practitioner (363LF0000X), and the practice location is in Deforest, WI. The record was last updated on Sep 12, 2023.