Individual
MEGHAN K MORTENSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1609 HUNTER RD, WAUKESHA, WI 53189-8220
(262) 524-1637
Mailing address
1674 EMERALD DR, GREEN BAY, WI 54311-6584
(920) 265-2649
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
176520
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
176520
WDSPS
WI
Enumeration date
06/04/2022
Last updated
06/04/2022
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