Individual
BONNIE S MUELLER-WAIGAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
575 4TH ST, KEWAUNEE, WI 54216-1785
(920) 388-4640
Mailing address
PO BOX 22487, GREEN BAY, WI 54305-2487
(920) 445-7222
(920) 445-7289
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1208
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1044380
NATIONAL COMMISSION ON CERTIFIED PHYSICIANS ASSISTANTS
—
01
—
1208-023
LICENSE
WI
Enumeration date
12/06/2005
Last updated
07/09/2020
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