Individual
DESIREE A MENGO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
248 MCHENRY ST, BURLINGTON, WI 53105
(262) 767-8000
(262) 767-8190
Mailing address
248 MCHENRY ST, BURLINGTON, WI 53105-1828
(262) 767-8000
(262) 767-8190
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
7584-33
WI
363LF0000X
Family Nurse Practitioner
7584-33
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10006568
—
WI
Enumeration date
03/10/2017
Last updated
03/07/2024
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