Provider Demographics
NPI:1467759498
Name:WILSON-WARD, ELIZABETH JEANNIE (MD, FACEP)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:JEANNIE
Last Name:WILSON-WARD
Suffix:
Gender:F
Credentials:MD, FACEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3621 S EMERALD DR
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-3962
Mailing Address - Country:US
Mailing Address - Phone:715-845-9805
Mailing Address - Fax:
Practice Address - Street 1:3621 S EMERALD DR
Practice Address - Street 2:
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-3962
Practice Address - Country:US
Practice Address - Phone:715-845-9805
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-02-28
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI30770207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIE70985Medicare UPIN