1013000108 NPI number — ELIZABETH ANN SKOV FPMHNP

Table of content: ELIZABETH ANN SKOV FPMHNP (NPI 1013000108)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013000108 NPI number — ELIZABETH ANN SKOV FPMHNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SKOV
Provider First Name:
ELIZABETH
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
FPMHNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SKOV
Provider Other First Name:
ANN
Provider Other Middle Name:
WHEDA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1013000108
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13807 COUNTY RD 347
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAIRVIEW
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59221
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-747-5732
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
316 2ND AVE W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILLISTON
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-774-4600
Provider Business Practice Location Address Fax Number:
701-774-4620
Provider Enumeration Date:
10/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  R23611 , registered in the state of ND ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 019440 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 54516 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com