Provider Demographics
NPI:1578038899
Name:DORO, ELIZABETH ANN (MSN, RN, CPNP-AC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANN
Last Name:DORO
Suffix:
Gender:F
Credentials:MSN, RN, CPNP-AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
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Mailing Address - Street 1:2062 BLACKFOOT AVE
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:WI
Mailing Address - Zip Code:53024-9581
Mailing Address - Country:US
Mailing Address - Phone:920-905-5499
Mailing Address - Fax:
Practice Address - Street 1:7861 STATE ROAD 60
Practice Address - Street 2:
Practice Address - City:CEDARBURG
Practice Address - State:WI
Practice Address - Zip Code:53012-9305
Practice Address - Country:US
Practice Address - Phone:262-546-1050
Practice Address - Fax:262-546-1051
Is Sole Proprietor?:No
Enumeration Date:2018-10-13
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8770208000000X, 363L00000X
WI8770-33363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100082427Medicaid