Individual provider Active NPI

Elizabeth Aspen Hathaway, MSN, APNP, AGNP-C

  • Primary Care Nurse Practitioner
  • Wauwatosa, WI
National Provider Identifier
1477332153
Registry record updated Jan 20, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Nurse PractitionerTaxonomy code 363LP2300X
License
14556-33 Issued in WI
Practice address
7400 W State St Apt 240
Wauwatosa, WI 53213-2772
Phone
(616) 570-7689
NPI assigned
Sep 22, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 20, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X 14556-33 WI
Gerontology Nurse Practitioner 363LG0600X 14556-33 WI
Primary Care Nurse Practitioner 363LP2300X 14556-33 WI Primary

Addresses

Primary practice location

7400 W State St Apt 240
Wauwatosa, WI 53213-2772

Mailing address

7400 W State St Apt 240
Wauwatosa, WI 53213-2772
Phone (616) 570-7689

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231010001111 WI Practitioner - Nurse Practitioner 5890140982

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science - Nursing

State licenses

LicenseStateTypeSpecialty
14556-33WIMDAdult Health Nurse Practitioner

NPI Registry JSON

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

{
    "created_epoch": "1695340800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737331200000",
    "number": "1477332153",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7400 W STATE ST APT 240",
            "city": "WAUWATOSA",
            "state": "WI",
            "postal_code": "532132772",
            "telephone_number": "616-570-7689"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7400 W STATE ST APT 240",
            "city": "WAUWATOSA",
            "state": "WI",
            "postal_code": "532132772",
            "telephone_number": "616-570-7689"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HATHAWAY",
        "first_name": "ELIZABETH",
        "middle_name": "ASPEN",
        "credential": "MSN, APNP, AGNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-09-22",
        "last_updated": "2025-01-20",
        "certification_date": "2025-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "WI",
            "license": "14556-33",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "WI",
            "license": "14556-33",
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "WI",
            "license": "14556-33",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wauwatosa, WI

Sources for this page

Verify at the official NPI Registry.