MATTHEW ALLAN MICKELSON NPI 1942907647

NPI Information

  • NPI: 1942907647
  • Provider Name: MATTHEW ALLAN MICKELSON
  • Classification: Nurse Practitioner - 363LF0000X
  • Specialization: Family
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 4200 SAVANNAH DR
    DEFOREST, WI
    ZIP 53532
  • Phone: (608) 417-3300

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NPI Details

Matthew Allan Mickelson is a family nurse practitioner in Deforest, WI with 3 years of experience. Matthew Allan Mickelson NPI is 1942907647. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

4200 SAVANNAH DR
DEFOREST, WI
ZIP 53532-909
Phone: (608) 417-3300

The NPI 1942907647 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 2/13/2023 and was last updated on 9/12/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1163W00000XRegistered Nurse241314WISCONSINNo
2363LF0000XNurse PractitionerFamily13661-33WISCONSINYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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