Individual
MATTHEW ALLAN MICKELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4200 SAVANNAH DR, DEFOREST, WI 53532-2909
(608) 417-3300
Mailing address
202 S PARK ST, MADISON, WI 53715-1507
(608) 417-6000
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
241314
WI
363LF0000X
Family Nurse Practitioner
Primary
13661-33
WI
Other
Enumeration date
02/13/2023
Last updated
09/12/2023
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