Provider Demographics
NPI:1578886578
Name:MATHSON, LIZA E (APNP)
Entity Type:Individual
Prefix:
First Name:LIZA
Middle Name:E
Last Name:MATHSON
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 689711
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53268-0001
Mailing Address - Country:US
Mailing Address - Phone:888-414-2509
Mailing Address - Fax:414-456-3113
Practice Address - Street 1:201 N MAYFAIR RD
Practice Address - Street 2:3RD FLOOR
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226-4216
Practice Address - Country:US
Practice Address - Phone:414-259-7480
Practice Address - Fax:414-256-4482
Is Sole Proprietor?:No
Enumeration Date:2010-03-04
Last Update Date:2010-03-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI3990363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health