Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225700000X | Massage Therapist | 13496-146 | WI |
NPI | 1003454505 |
---|---|
Provider Name | Elizabeth Ann Michelsen |
First Address | Madison, WI 53704-5042 |
Second Address | Barneveld, WI 53507-9801 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/12/2019 |
Last Update Date | 15/12/2019 |