Provider Demographics
NPI:1710289384
Name:DIERMEIER, ELISA MARIE (APNP)
Entity Type:Individual
Prefix:
First Name:ELISA
Middle Name:MARIE
Last Name:DIERMEIER
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2801 W KINNICKINNIC RIVER PKWY
Mailing Address - Street 2:SUITE 1030
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-3669
Mailing Address - Country:US
Mailing Address - Phone:414-908-6500
Mailing Address - Fax:414-908-6565
Practice Address - Street 1:3111 W RAWSON AVE
Practice Address - Street 2:SUITE 240
Practice Address - City:FRANKLIN
Practice Address - State:WI
Practice Address - Zip Code:53132-9417
Practice Address - Country:US
Practice Address - Phone:414-908-6620
Practice Address - Fax:414-761-1829
Is Sole Proprietor?:No
Enumeration Date:2010-12-02
Last Update Date:2018-12-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI7121-33363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner