Individual
LISA ELLIOTT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1155 N MAYFAIR RD, MILWAUKEE, WI 53226-3462
(414) 955-7199
(414) 955-0110
Mailing address
2434 S LOGAN AVE, MILWAUKEE, WI 53207-1772
(815) 505-1692
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
9581-33
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1437796091
—
WI
Enumeration date
12/03/2019
Last updated
06/23/2021
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