Provider Demographics
NPI:1588900609
Name:MIELKE, REBECCA ANN (APNP)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:ANN
Last Name:MIELKE
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1881 COUNTY ROAD XX
Mailing Address - Street 2:
Mailing Address - City:KRONENWETTER
Mailing Address - State:WI
Mailing Address - Zip Code:54455-7933
Mailing Address - Country:US
Mailing Address - Phone:715-355-4040
Mailing Address - Fax:
Practice Address - Street 1:1881 COUNTY ROAD XX
Practice Address - Street 2:
Practice Address - City:KRONENWETTER
Practice Address - State:WI
Practice Address - Zip Code:54455-7933
Practice Address - Country:US
Practice Address - Phone:715-355-4040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-18
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI5184-33363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology