Provider Demographics
NPI:1730296203
Name:MEHNER, ROBERT W (PA-C)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:W
Last Name:MEHNER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:W336S9209 VALLEY VIEW DR
Mailing Address - Street 2:
Mailing Address - City:MUKWONAGO
Mailing Address - State:WI
Mailing Address - Zip Code:53149-8218
Mailing Address - Country:US
Mailing Address - Phone:262-594-2607
Mailing Address - Fax:
Practice Address - Street 1:W3985 COUNTY RD NN
Practice Address - Street 2:
Practice Address - City:ELKHORN
Practice Address - State:WI
Practice Address - Zip Code:53121
Practice Address - Country:US
Practice Address - Phone:262-741-2928
Practice Address - Fax:262-741-2812
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI859-023363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MM0185668OtherDEA NUMBER
MM0185668OtherDEA NUMBER