Individual
MICHELLE NIESEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1180 PRAIRIE ST, PRAIRIE DU SAC, WI 53578-2044
(608) 434-6600
Mailing address
1180 PRAIRIE ST, PRAIRIE DU SAC, WI 53578-2044
(608) 434-6600
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1075
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
42973700
—
WI
Enumeration date
09/20/2006
Last updated
06/24/2024
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