Most Relevant Information
Provider Data
| NPI Number: | 1003573841 |
| Provider Name: | ELISSA M DERKSEN LPN |
| Entity Type: | Individual |
| Taxonomy Code: | 164W00000X |
| Specialty: | Licensed Practical Nurse |
| License Number: | 30994431 |
Most Important Dates
| Enumeration Date: | 11/28/2021 |
| Last Updated: | 11/28/2021 |
Provider Practice Location
2422 N GRANDVIEW BLVD
WAUKESHA
WI
531886105
Practice Location Phone/Fax
| Phone: | 2625496600 |
| Fax: |
Provider Mailing Location
407 HARTWOOD LN
HARTLAND
WI
530292409
Provider Mailing Phone/Fax
| Phone: | 9203092018 |
| Fax: |