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General NPI Number Information
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NPI Number | 1245914563
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Entity Type | Individual
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Provider Name | ELIZABETH ASHLEY DIFFELY FNP-C
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Gender | Female
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Dates
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Enumeration Date | 06/15/2023
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Last Update Date | 08/23/2023
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Provider Practice Location Address
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Address Line | 437 3RD AVE SE
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City | GARRISON
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State | ND
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Zip | 58540-7235
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Country | US
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Telephone | 701-463-6551
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Fax |
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Provider Business Mailing Address
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Address Line | 437 3RD AVE SE
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City | GARRISON
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State | ND
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Zip | 58540-7235
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Country | US
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Telephone | 701-463-6551
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Fax |
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | F06350881
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License Number State | ND
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | R36507
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License Number State | ND
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