Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 7668 | WI |
NPI | 1003006099 |
---|---|
Provider Name | Elizabeth Ostoja |
First Address | Green Bay, WI 54305-2487 |
Second Address | Green Bay, WI 54311-4417 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2007 |
Last Update Date | 17/03/2020 |