Individual
MIKAYLA NISWONGER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
788 N JEFFERSON ST STE 401, MILWAUKEE, WI 53202-3718
(414) 226-4020
(414) 225-2929
Mailing address
788 N JEFFERSON ST STE 300, MILWAUKEE, WI 53202-3710
(414) 272-8950
(414) 225-2929
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1659923795
—
WI
Enumeration date
07/09/2019
Last updated
08/03/2021
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