Provider Demographics
NPI:1235641804
Name:RALSTON, ELIZABETH MYUNGHEE (APN)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:MYUNGHEE
Last Name:RALSTON
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3803 SPRING ST STE 410
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:WI
Mailing Address - Zip Code:53405-1660
Mailing Address - Country:US
Mailing Address - Phone:262-687-8260
Mailing Address - Fax:262-687-8729
Practice Address - Street 1:3803 SPRING ST STE 410
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:WI
Practice Address - Zip Code:53405-1660
Practice Address - Country:US
Practice Address - Phone:262-687-8260
Practice Address - Fax:262-687-8729
Is Sole Proprietor?:No
Enumeration Date:2017-11-03
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL209016700363LF0000X
WI8929363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily