Provider Demographics
NPI:1225815269
Name:MIESEN, ANN MARIE (BSN, RN)
Entity Type:Individual
Prefix:MRS
First Name:ANN
Middle Name:MARIE
Last Name:MIESEN
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:MARIE
Other - Last Name:LANGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:3375 MCADAM ROAD
Mailing Address - Street 2:
Mailing Address - City:CUBA CITY
Mailing Address - State:WI
Mailing Address - Zip Code:53807-9804
Mailing Address - Country:US
Mailing Address - Phone:563-543-3197
Mailing Address - Fax:
Practice Address - Street 1:3548 SANDY HOOK ROAD
Practice Address - Street 2:
Practice Address - City:HAZEL GREEN
Practice Address - State:WI
Practice Address - Zip Code:53811-9699
Practice Address - Country:US
Practice Address - Phone:563-543-3197
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-13
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI77025-30163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health