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General NPI Number Information
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NPI Number | 1649152240
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Entity Type | Individual
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Provider Name | ELIZABETH RACHEL MATHU APNP
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Gender | Female
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Dates
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Enumeration Date | 07/23/2025
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Last Update Date | 08/03/2025
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Provider Practice Location Address
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Address Line | 1385 W MAIN AVE
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City | DE PERE
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State | WI
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Zip | 54115
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Country | US
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Telephone | 920-433-9400
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Fax |
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Provider Business Mailing Address
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Address Line | 852 LONE OAK RD
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City | DE PERE
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State | WI
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Zip | 54115-3361
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Country | US
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Telephone | 920-639-9696
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 17111-33
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License Number State | WI
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