Individual
ELIZABETH JANE TLACHAC
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2845 GREENBRIER RD, GREEN BAY, WI 54311-6519
(920) 490-9046
Mailing address
PO BOX 28900, GREEN BAY, WI 54324-0900
(920) 490-9046
Taxonomy
Speciality
Code
Description
License number
State
163WX0003X
Inpatient Obstetric Registered Nurse
223849
WI
363L00000X
Nurse Practitioner
Primary
13119
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100228350
—
WI
Enumeration date
09/06/2018
Last updated
04/19/2023
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