Individual
MICHELLE MORTENSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2844 INDEX RD, FITCHBURG, WI 53713-3117
(608) 229-7979
(608) 229-8110
Mailing address
1808 W BELTLINE HWY, MADISON, WI 53713-2334
(608) 250-1497
(608) 250-1384
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
3989-23
WI
363A00000X
Physician Assistant
PA9109846
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1972052371
—
WI
Enumeration date
09/26/2016
Last updated
12/29/2020
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