Healthcare Provider Details

I. General information

NPI: 1407557499
Provider Name (Legal Business Name): ELZATA WOODLAND
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2023
Last Update Date: 03/15/2023
Certification Date: 03/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2408 W HADLEY ST
MILWAUKEE WI
53206-1157
US

IV. Provider business mailing address

2408 W HADLEY ST
MILWAUKEE WI
53206-1157
US

V. Phone/Fax

Practice location:
  • Phone: 414-712-2948
  • Fax:
Mailing address:
  • Phone: 414-712-2948
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: