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NPI Code Detail

MEDICARE: ELIZABETH A WIBORG RN CNP

MEDICARE: ELIZABETH A WIBORG RN CNP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LG0600XGerontology Nurse PractitionerR 94784-6MN
2363LG0600XGerontology Nurse PractitionerCNP 2753MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1154380871
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELIZABETH A WIBORG RN CNP
Provider Business Mailing Address
First Line : 7755 CENTER AVE
Second Line : STE 630
City : HUNTINGTON BEACH
State : CA
Zip : 92647-9152
Country : US
Telephone Number : 657-400-5180
Fax Number :
Provider Business Practice Location Address
First Line : 2450 26TH AVE S
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55406-1245
Country : US
Telephone Number : 612-721-2491
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/21/2006
Last Update Date : 01/08/2020

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