Provider Demographics
NPI:1013961077
Name:NELSON-BIERSACH, MARY ELIZABETH S (NP)
Entity Type:Individual
Prefix:MS
First Name:MARY ELIZABETH
Middle Name:S
Last Name:NELSON-BIERSACH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:MARY ELIZABETH
Other - Middle Name:SCHMITZ
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:9200 W WISCONSIN AVE
Mailing Address - Street 2:DEPT OF PHYSICAL MEDICINE AND REHABILITATION
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3522
Mailing Address - Country:US
Mailing Address - Phone:414-905-7349
Mailing Address - Fax:414-805-7348
Practice Address - Street 1:9200 W WISCONSIN AVE
Practice Address - Street 2:DEPT OF PHYSICAL MEDICINE AND REHABILITATION
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3522
Practice Address - Country:US
Practice Address - Phone:414-905-7349
Practice Address - Fax:414-805-7348
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI131442363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
007000261TOtherHUMANA
WI1013961077Medicaid
WI680861125Medicare PIN
007000261TOtherHUMANA
WI1013961077Medicaid