Provider Demographics
NPI:1164238630
Name:ULLSPERGER, MEHGAN (RN)
Entity type:Individual
Prefix:MISS
First Name:MEHGAN
Middle Name:
Last Name:ULLSPERGER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W7609 CHICAGO CT
Mailing Address - Street 2:
Mailing Address - City:WAUTOMA
Mailing Address - State:WI
Mailing Address - Zip Code:54982-9025
Mailing Address - Country:US
Mailing Address - Phone:920-312-2402
Mailing Address - Fax:
Practice Address - Street 1:3000 E COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54915-3251
Practice Address - Country:US
Practice Address - Phone:920-969-0919
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-09
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI18236830163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health