Individual
MS. DEBRA LEE MICKELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDH
Contact information
Practice address
1814 APPLETON RD, MENASHA, WI 54952-1110
(920) 731-7445
(920) 731-7490
Mailing address
1814 APPLETON RD, MENASHA, WI 54952-1110
(920) 731-7445
(920) 731-7490
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
10011956
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1001956
WISCONSIN HYGIENE LICENSE
WI
Enumeration date
11/05/2010
Last updated
11/05/2010
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