Provider Demographics
NPI:1407557499
Name:WOODLAND, ELZATA
Entity Type:Individual
Prefix:
First Name:ELZATA
Middle Name:
Last Name:WOODLAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2408 W HADLEY ST
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53206-1157
Mailing Address - Country:US
Mailing Address - Phone:414-712-2948
Mailing Address - Fax:
Practice Address - Street 1:2408 W HADLEY ST
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53206-1157
Practice Address - Country:US
Practice Address - Phone:414-712-2948
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-15
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
No171M00000XOther Service ProvidersCase Manager/Care Coordinator