Healthcare Provider Details

I. General information

NPI: 1891732293
Provider Name (Legal Business Name): ELIZABETH M SILLERS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELIZABETH M LARSON FNP

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 2ND ST
LANGDON ND
58249-2407
US

IV. Provider business mailing address

901 2ND ST
LANGDON ND
58249-2407
US

V. Phone/Fax

Practice location:
  • Phone: 701-256-6120
  • Fax: 701-256-6156
Mailing address:
  • Phone: 701-256-6120
  • Fax: 701-256-6156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR26936
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: