Healthcare Provider Details

I. General information

NPI: 1710367115
Provider Name (Legal Business Name): ELIZABETH WEIX
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2015
Last Update Date: 09/29/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 STERLING HEIGHTS CT APT6
GREEN BAY WI
54302-2177
US

IV. Provider business mailing address

1400 STERLING HEIGHTS CT APT6
GREEN BAY WI
54302-2177
US

V. Phone/Fax

Practice location:
  • Phone: 715-351-0709
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number196867
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: