Individual
ELISSA M DERKSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
2422 N GRANDVIEW BLVD, WAUKESHA, WI 53188-6105
(262) 549-6600
Mailing address
407 HARTWOOD LN, HARTLAND, WI 53029-2409
(920) 309-2018
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
30994431
WI
Other
Enumeration date
11/28/2021
Last updated
11/28/2021
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