Basic Information
| Provider Information | |||||||||
| NPI: | 1053965822 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HORWATH | ||||||||
| FirstName: | ELIZABETH | ||||||||
| MiddleName: | LEE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | MSN, RN, AGACNP, FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 4 | ||||||||
| Address2: | |||||||||
| City: | CONOVER | ||||||||
| State: | WI | ||||||||
| PostalCode: | 545190004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7156175255 | ||||||||
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| Practice Location | |||||||||
| Address1: | 240 MAPLE ST | ||||||||
| Address2: | |||||||||
| City: | WOODRUFF | ||||||||
| State: | WI | ||||||||
| PostalCode: | 545689190 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7153568140 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/30/2019 | ||||||||
| LastUpdateDate: | 07/30/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2100X | 9149-33 | WI | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Acute Care | 363LF0000X | 9149-33 | WI | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.