Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | R23611 | ND |
NPI | 1013000108 |
---|---|
Provider Name | Elizabeth Ann Skov |
First Address | Fairview, MT 59221 |
Second Address | Williston, ND 58801 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
019440 | BCBS (01) | |
54516 | (05) | ND |
MS0319613 | (02) |