Elissa M Derksen, LPN

Primary specialty

Licensed Practical NurseTaxonomy code 164W00000X

License

30994431 Issued in WI

Practice address

2422 N Grandview Blvd
Waukesha, WI 53188-6105

Phone

(262) 549-6600

NPI assigned

Nov 28, 2021

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1638057600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638057600000",
    "number": "1003573841",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "407 HARTWOOD LN",
            "city": "HARTLAND",
            "state": "WI",
            "postal_code": "530292409",
            "telephone_number": "920-309-2018"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2422 N GRANDVIEW BLVD",
            "city": "WAUKESHA",
            "state": "WI",
            "postal_code": "531886105",
            "telephone_number": "262-549-6600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DERKSEN",
        "first_name": "ELISSA",
        "middle_name": "M",
        "credential": "LPN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-11-28",
        "last_updated": "2021-11-28",
        "certification_date": "2021-11-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "164W00000X",
            "taxonomy_group": "",
            "desc": "Licensed Practical Nurse",
            "state": "WI",
            "license": "30994431",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jody Denny, RDH
• Denoon Recovery LLC
• Dental 360 Waukesha LLC
• Tammy Depies, BSW
• Pamela Faye Derby, M.S.
• Keyur Desai, MD
• Maribeth Rose Dettlaff, MSW, LCSW, CADC
• Richard R. Dettlaff, BS,CSAC
• Jean Deuster, M.D.
• Jerrold M. Deutsch, MD

• Licensed Practical Nurse in Waukesha, WI
• Providers in Waukesha, WI by specialty
• Licensed Practical Nurse in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.