Healthcare Provider Details

I. General information

NPI: 1366301178
Provider Name (Legal Business Name): ELIZABETH CLAIRE MYSTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4570 S 27TH ST
MILWAUKEE WI
53221-2145
US

IV. Provider business mailing address

1032 S CESAR E CHAVEZ DR
MILWAUKEE WI
53204-2203
US

V. Phone/Fax

Practice location:
  • Phone: 414-897-5602
  • Fax: 262-408-5094
Mailing address:
  • Phone: 414-897-5602
  • Fax: 262-408-5094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: