Healthcare Provider Details

I. General information

NPI: 1013000108
Provider Name (Legal Business Name): ELIZABETH ANN SKOV FPMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANN WHEDA SKOV

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 2ND AVE W
WILLISTON ND
58801
US

IV. Provider business mailing address

13807 COUNTY RD 347
FAIRVIEW MT
59221
US

V. Phone/Fax

Practice location:
  • Phone: 701-774-4600
  • Fax: 701-774-4620
Mailing address:
  • Phone: 406-747-5732
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR23611
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: