MEDICARE: ELIZABETH EMILY PAUL 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
1	363LF0000X	Family Nurse Practitioner	CP002468	SD

General Provider Information

NPI Number	:	1568197580
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH EMILY PAUL CNP

Provider Business Mailing Address
First Line	:	408 S 1ST ST
Second Line	:
City	:	PARKSTON
State	:	SD
Zip	:	57366-2255
Country	:	US
Telephone Number	:	605-216-9154
Fax Number	:

Provider Business Practice Location Address
First Line	:	1412 WOOD ST
Second Line	:
City	:	SPRINGFIELD
State	:	SD
Zip	:	57062-2238
Country	:	US
Telephone Number	:	605-369-2201
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/22/2022
Last Update Date	:	07/22/2022

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