Healthcare Provider Details

I. General information

NPI: 1609794189
Provider Name (Legal Business Name): ELIZABETH JOSEPHINE PAXTON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 8TH ST N APT 104
FARGO ND
58102-1470
US

IV. Provider business mailing address

2800 8TH ST N APT 104
FARGO ND
58102-1470
US

V. Phone/Fax

Practice location:
  • Phone: 507-402-8679
  • Fax:
Mailing address:
  • Phone: 507-402-8679
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberL572118840914
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: