Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LG0600X | Nurse Practitioner - Gerontology | 7618-33 | WI |
NPI | 1083147334 |
---|---|
Provider Name | Elizabeth Apollo-Loomis |
First Address | West Bend, WI 53090-2545 |
Second Address | Nashville, TN 37214-3162 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2017 |
Last Update Date | 04/04/2017 |