Healthcare Provider Details

I. General information

NPI: 1902726219
Provider Name (Legal Business Name): ELIZABETH NICOLE BLOCK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

N5W31601 HUCKLEBERRY WAY S
DELAFIELD WI
53018-2833
US

IV. Provider business mailing address

N5W31601 HUCKLEBERRY WAY S
DELAFIELD WI
53018-2833
US

V. Phone/Fax

Practice location:
  • Phone: 262-337-4835
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: