1215135348 NPI number — MRS. ELIZABETH ANN O'NEILL MS ARNP-BC

Table of content: MRS. ELIZABETH ANN O'NEILL MS ARNP-BC (NPI 1215135348)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215135348 NPI number — MRS. ELIZABETH ANN O'NEILL MS ARNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
O'NEILL
Provider First Name:
ELIZABETH
Provider Middle Name:
ANN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MS ARNP-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HARDEN
Provider Other First Name:
ELIZABETH
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1215135348
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/14/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1000 E 23RD ST
Provider Second Line Business Mailing Address:
SUITE #230
Provider Business Mailing Address City Name:
SIOUX FALLS
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57105-2108
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-322-7334
Provider Business Mailing Address Fax Number:
605-322-6738

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1000 E 23RD ST
Provider Second Line Business Practice Location Address:
SUITE #230
Provider Business Practice Location Address City Name:
SIOUX FALLS
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57105-2108
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-322-7334
Provider Business Practice Location Address Fax Number:
605-322-6738
Provider Enumeration Date:
07/10/2007

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:  CP000514 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 6833380 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".




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