Healthcare Provider Details

I. General information

NPI: 1972887453
Provider Name (Legal Business Name): ELIZABETH RUTH HALL-MOTEN REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ELIZABETH RUTH MONTGOMERY REGISTERED NURSE

II. Dates (important events)

Enumeration Date: 10/03/2011
Last Update Date: 06/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9009 NORTH FM 620 STE 1313
AUSTIN TX
78726-4200
US

IV. Provider business mailing address

9009 N FM 620 STE 1313
AUSTIN TX
78726-4200
US

V. Phone/Fax

Practice location:
  • Phone: 512-367-9049
  • Fax: 512-551-2096
Mailing address:
  • Phone: 512-367-9049
  • Fax: 512-551-2096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number758363
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: