Healthcare Provider Details

I. General information

NPI: 1477132728
Provider Name (Legal Business Name): KATARINA NICOLE ELYEA NURSE PRACTITIONER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATARINA NICOLE TREIBER

II. Dates (important events)

Enumeration Date: 04/05/2021
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6611 SPRING ST
MOUNT PLEASANT WI
53406-2632
US

IV. Provider business mailing address

PO BOX 735044
CHICAGO IL
60673-5044
US

V. Phone/Fax

Practice location:
  • Phone: 262-504-3100
  • Fax:
Mailing address:
  • Phone: 800-326-2250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number10516
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number10516-33
License Number StateWI
# 3
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number209023339
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: