Healthcare Provider Details

I. General information

NPI: 1245631829
Provider Name (Legal Business Name): ELIZABETH ANN LARSON APNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH A GOLDBERG

II. Dates (important events)

Enumeration Date: 09/15/2014
Last Update Date: 02/26/2025
Certification Date: 02/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 HIGHLAND AVE
MADISON WI
53792-4800
US

IV. Provider business mailing address

7974 UW HEALTH CT
MIDDLETON WI
53562-5531
US

V. Phone/Fax

Practice location:
  • Phone: 608-263-6100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number15947
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberR186186
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR186186
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR186186
License Number StateMD
# 5
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number15947
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: