Healthcare Provider Details

I. General information

NPI: 1952035230
Provider Name (Legal Business Name): ELIZABETH WSZALEK PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2022
Last Update Date: 11/04/2024
Certification Date: 11/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5146 JUNEAU RD
MADISON WI
53705-4744
US

IV. Provider business mailing address

5146 JUNEAU RD
MADISON WI
53705-4744
US

V. Phone/Fax

Practice location:
  • Phone: 608-772-0481
  • Fax:
Mailing address:
  • Phone: 608-772-0481
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number8024-23
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: