Provider Demographics
NPI:1548071210
Name:MICKELSON, LINDSEY J (APNP)
Entity type:Individual
Prefix:
First Name:LINDSEY
Middle Name:J
Last Name:MICKELSON
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 1:2701 E ENTERPRISE AVE
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54913-7729
Mailing Address - Country:US
Mailing Address - Phone:920-954-2551
Mailing Address - Fax:920-954-2554
Practice Address - Street 1:2701 E ENTERPRISE AVE
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54913-7729
Practice Address - Country:US
Practice Address - Phone:920-954-2551
Practice Address - Fax:920-954-2554
Is Sole Proprietor?:No
Enumeration Date:2025-01-14
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1636833363LP0200X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics