Provider Demographics
NPI:1477332153
Name:HATHAWAY, ELIZABETH ASPEN (MSN, APNP, AGNP-C)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ASPEN
Last Name:HATHAWAY
Suffix:
Gender:F
Credentials:MSN, APNP, AGNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7400 W STATE ST APT 240
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53213-2772
Mailing Address - Country:US
Mailing Address - Phone:616-570-7689
Mailing Address - Fax:
Practice Address - Street 1:7400 W STATE ST APT 240
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53213-2772
Practice Address - Country:US
Practice Address - Phone:616-570-7689
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-22
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14556-33363LA2200X, 363LG0600X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology