Provider Demographics
NPI:1841673829
Name:MEULEMANS, M CHRISTINE (NP)
Entity type:Individual
Prefix:
First Name:M CHRISTINE
Middle Name:
Last Name:MEULEMANS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:M
Other - Middle Name:CHRISTINE
Other - Last Name:JANSSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:424 ERNEST ST
Mailing Address - Street 2:
Mailing Address - City:GREEN LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:54941-9501
Mailing Address - Country:US
Mailing Address - Phone:920-573-2107
Mailing Address - Fax:
Practice Address - Street 1:3391 WILDERNESS TRL
Practice Address - Street 2:
Practice Address - City:SUAMICO
Practice Address - State:WI
Practice Address - Zip Code:54313-8746
Practice Address - Country:US
Practice Address - Phone:920-573-2107
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-08
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI513255363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health