Healthcare Provider Details

I. General information

NPI: 1710289384
Provider Name (Legal Business Name): ELISA MARIE DIERMEIER APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2010
Last Update Date: 12/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3111 W RAWSON AVE SUITE 240
FRANKLIN WI
53132-9417
US

IV. Provider business mailing address

2801 W KINNICKINNIC RIVER PKWY SUITE 1030
MILWAUKEE WI
53215-3669
US

V. Phone/Fax

Practice location:
  • Phone: 414-908-6620
  • Fax: 414-761-1829
Mailing address:
  • Phone: 414-908-6500
  • Fax: 414-908-6565

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number7121-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: