Healthcare Provider Details

I. General information

NPI: 1710687546
Provider Name (Legal Business Name): ELIZABETH CASTILLO APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2023
Last Update Date: 06/21/2023
Certification Date: 06/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3111 E BROADWAY AVE
BISMARCK ND
58501-5085
US

IV. Provider business mailing address

3111 E BROADWAY AVE
BISMARCK ND
58501-5085
US

V. Phone/Fax

Practice location:
  • Phone: 701-751-0299
  • Fax: 701-751-2940
Mailing address:
  • Phone: 701-751-0299
  • Fax: 701-751-2940

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR35228
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: