Healthcare Provider Details

I. General information

NPI: 1508349341
Provider Name (Legal Business Name): ELIZABETH MICHAEL DVORAK FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH MICHAEL KRANTZ FNP

II. Dates (important events)

Enumeration Date: 09/07/2018
Last Update Date: 09/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 N MILES AVE
HARDIN MT
59034-2323
US

IV. Provider business mailing address

1122 1/2 8TH ST W
BILLINGS MT
59101-5828
US

V. Phone/Fax

Practice location:
  • Phone: 406-665-2310
  • Fax: 406-665-9238
Mailing address:
  • Phone: 406-647-5426
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNUR-APRN-LIC-131606
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: