Healthcare Provider Details

I. General information

NPI: 1841673829
Provider Name (Legal Business Name): M CHRISTINE MEULEMANS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: M CHRISTINE JANSSEN RN

II. Dates (important events)

Enumeration Date: 07/08/2015
Last Update Date: 03/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3391 WILDERNESS TRL
SUAMICO WI
54313-8746
US

IV. Provider business mailing address

424 ERNEST ST
GREEN LAKE WI
54941-9501
US

V. Phone/Fax

Practice location:
  • Phone: 920-573-2107
  • Fax:
Mailing address:
  • Phone: 920-573-2107
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number513255
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: