Provider Demographics
NPI:1194595447
Name:MESKE, MICHELLE NICOLE (AGACNP)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:NICOLE
Last Name:MESKE
Suffix:
Gender:F
Credentials:AGACNP
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:NICOLE
Other - Last Name:STROHM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:340 NATURE PL
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CREEK
Mailing Address - State:WI
Mailing Address - Zip Code:53038-9300
Mailing Address - Country:US
Mailing Address - Phone:920-723-9262
Mailing Address - Fax:
Practice Address - Street 1:1260 SENTRY DR STE 140
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53186-5990
Practice Address - Country:US
Practice Address - Phone:262-524-1024
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-08
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI168435163WH0500X
WI15004-33363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163WH0500XNursing Service ProvidersRegistered NurseHemodialysis