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General NPI Number Information
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NPI Number | 1114381845
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Entity Type | Individual
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Provider Name | ELIZABETH BOOTS RN
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Gender | Female
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Dates
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Enumeration Date | 04/08/2016
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Last Update Date | 10/22/2020
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Provider Practice Location Address
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Address Line | 316 2ND AVE W
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City | WILLISTON
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State | ND
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Zip | 58801-5218
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Country | US
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Telephone | 701-774-4600
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Fax | 701-774-4620
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Provider Business Mailing Address
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Address Line | PO BOX 1266
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City | WILLISTON
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State | ND
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Zip | 58802-1266
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Country | US
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Telephone | 701-774-4600
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Fax | 701-774-4620
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | R37699
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License Number State | ND
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | R37699
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License Number State | ND
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