Healthcare Provider Details

I. General information

NPI: 1356915938
Provider Name (Legal Business Name): ELIZABETH WISCHER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2021
Last Update Date: 10/17/2022
Certification Date: 10/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4416 N WINDINGBROOK DR
APPLETON WI
54913-7762
US

IV. Provider business mailing address

4416 N WINDINGBROOK DR
APPLETON WI
54913-7762
US

V. Phone/Fax

Practice location:
  • Phone: 262-455-5655
  • Fax:
Mailing address:
  • Phone: 262-455-5655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number10865-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: