MEDICARE: ELIZABETH MARGUERITE ERNHART

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1508403007
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH MARGUERITE ERNHART

Provider Business Mailing Address
First Line	:	3910 YANCY AVE
Second Line	:
City	:	NEW GERMANY
State	:	MN
Zip	:	55367-9319
Country	:	US
Telephone Number	:	612-760-1662
Fax Number	:

Provider Business Practice Location Address
First Line	:	3910 YANCY AVE
Second Line	:
City	:	NEW GERMANY
State	:	MN
Zip	:	55367-9319
Country	:	US
Telephone Number	:	612-760-1662
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/03/2019
Last Update Date	:	12/03/2019

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