Healthcare Provider Details

I. General information

NPI: 1225294101
Provider Name (Legal Business Name): CAREY ELIZABETH RIVINIUS NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2008
Last Update Date: 07/31/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 EAST ST N
ELGIN ND
58533-7105
US

IV. Provider business mailing address

601 EAST ST N
ELGIN ND
58533-7105
US

V. Phone/Fax

Practice location:
  • Phone: 701-584-3338
  • Fax: 701-584-3048
Mailing address:
  • Phone: 701-584-3338
  • Fax: 701-584-3048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR29062
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: