Provider Demographics
NPI:1013000108
Name:SKOV, ELIZABETH ANN (FPMHNP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ANN
Last Name:SKOV
Suffix:
Gender:F
Credentials:FPMHNP
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:WHEDA
Other - Last Name:SKOV
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:13807 COUNTY RD 347
Mailing Address - Street 2:
Mailing Address - City:FAIRVIEW
Mailing Address - State:MT
Mailing Address - Zip Code:59221
Mailing Address - Country:US
Mailing Address - Phone:406-747-5732
Mailing Address - Fax:
Practice Address - Street 1:316 2ND AVE W
Practice Address - Street 2:
Practice Address - City:WILLISTON
Practice Address - State:ND
Practice Address - Zip Code:58801
Practice Address - Country:US
Practice Address - Phone:701-774-4600
Practice Address - Fax:701-774-4620
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR23611363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
019440OtherBCBS
ND54516Medicaid
ND54516Medicaid
MS0319613Medicare UPIN