Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Matthew Allan Mickelson

Individual provider Registered Nurse · NPI 1942907647

Matthew Allan Mickelson is a Nurse Practitioner in Deforest, Wisconsin. Qualified in 2022, 4 years ago. Practices with Prohealth Medical Group Inc, a 472-clinician group and accepts Medicare assignment. Licensed in Wisconsin.

Years since qualifying
4
Licensed in
WI
In the registry since
2023
Specialties on file
2
Claim this listing Report a problem Suggest an edit

Practice location Address checks out

4200 Savannah Dr
Deforest, WI 53532-2909
Phone: (608) 417-3300
Show map & directions

Directions in Google Maps · Apple Maps · OpenStreetMap

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Nurse Practitioner (primary) Taxonomy 363LF0000X · Licence 13661-33 (WI)
Registered Nurse Taxonomy 163W00000X · Licence 241314 (WI)

Record details

NPI number1942907647
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedFebruary 13, 2023
Last updated in NPPESSeptember 12, 2023
Certification dateSeptember 11, 2023
Mailing address202 S Park St, Madison, WI 53715-1507

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2022 (4 years in practice)
Group practice Prohealth Medical Group Inc — 472 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

Other providers in Deforest