Provider Demographics
NPI:1063959096
Name:AKSELRUD, ELENA
Entity type:Individual
Prefix:
First Name:ELENA
Middle Name:
Last Name:AKSELRUD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10640 N IVY CT UNIT 2
Mailing Address - Street 2:
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53092-5027
Mailing Address - Country:US
Mailing Address - Phone:414-828-8344
Mailing Address - Fax:
Practice Address - Street 1:10640 N IVY CT UNIT 2
Practice Address - Street 2:
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092-5027
Practice Address - Country:US
Practice Address - Phone:414-828-8344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-29
Last Update Date:2017-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI175989163W00000X
WI7489-33363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse