1003454505 NPI number — ELIZABETH ANN MICHELSEN LMT

Table of content: ELIZABETH ANN MICHELSEN LMT (NPI 1003454505)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003454505 NPI number — ELIZABETH ANN MICHELSEN LMT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MICHELSEN
Provider First Name:
ELIZABETH
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LMT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MICHELSEN
Provider Other First Name:
LIZ
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LMT
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1003454505
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/15/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
317 PAWLING ST APT 4
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MADISON
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53704-5042
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
608-445-9055
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 S JONES ST STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BARNEVELD
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53507-9801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
608-924-2424
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/15/2019

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225700000X , with the licence number:  13496-146 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)