Healthcare Provider Details

I. General information

NPI: 1982637310
Provider Name (Legal Business Name): ELIZABETH W CHILTON ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 09/29/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1021 NEBRASKA ST
SIOUX CITY IA
51104-5410
US

IV. Provider business mailing address

1021 NEBRASKA ST P.O. BOX 5410
SIOUX CITY IA
51105-1436
US

V. Phone/Fax

Practice location:
  • Phone: 712-252-2477
  • Fax: 712-252-5516
Mailing address:
  • Phone: 712-252-2477
  • Fax: 712-252-5516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCP000243
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: