Provider Demographics
NPI:1982239786
Name:ELIASSON, HAYLEE AMBER (NP)
Entity Type:Individual
Prefix:MRS
First Name:HAYLEE
Middle Name:AMBER
Last Name:ELIASSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:HAYLEE
Other - Middle Name:A
Other - Last Name:MARESCALCO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6211 DURAND AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:WI
Mailing Address - Zip Code:53406-4956
Mailing Address - Country:US
Mailing Address - Phone:262-898-9000
Mailing Address - Fax:
Practice Address - Street 1:7003 BRAUN RD
Practice Address - Street 2:
Practice Address - City:MOUNT PLEASANT
Practice Address - State:WI
Practice Address - Zip Code:53403-9743
Practice Address - Country:US
Practice Address - Phone:262-206-7018
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-12
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9953-33363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100140735Medicaid