Healthcare Provider Details

I. General information

NPI: 1467923409
Provider Name (Legal Business Name): ELIZABETH M ULLIG NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2018
Last Update Date: 06/12/2025
Certification Date: 06/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3305 S 20TH ST
MILWAUKEE WI
53215-4940
US

IV. Provider business mailing address

3305 S 20TH ST
MILWAUKEE WI
53215-4940
US

V. Phone/Fax

Practice location:
  • Phone: 414-645-1808
  • Fax: 414-645-1170
Mailing address:
  • Phone: 414-645-1808
  • Fax: 414-645-1170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number8862
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number8862-33
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: