Individual
ELIZABETH DIANE NELSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN
Contact information
Practice address
924 S 74TH ST, WEST ALLIS, WI 53214-3003
(608) 317-4663
Mailing address
924 S 74TH STREET, WEST ALLIS, WI 53214
(608) 317-4663
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
304156-031
WI
Other
Enumeration date
09/02/2009
Last updated
09/02/2009
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