Provider Demographics
NPI:1053886465
Name:JARECKI, ELIZABETH A (APNP)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:JARECKI
Suffix:
Gender:F
Credentials:APNP
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:A
Other - Last Name:KARA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APNP
Mailing Address - Street 1:3115 LILLY RD UNIT 209
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53005-7612
Mailing Address - Country:US
Mailing Address - Phone:414-530-3460
Mailing Address - Fax:
Practice Address - Street 1:3115 LILLY RD UNIT 209
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-7612
Practice Address - Country:US
Practice Address - Phone:414-530-3460
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-11
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8754363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care