Provider Demographics
NPI:1477845741
Name:HOUSE, ELIZAVETA (APRN)
Entity Type:Individual
Prefix:MS
First Name:ELIZAVETA
Middle Name:
Last Name:HOUSE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MS
Other - First Name:LIZA
Other - Middle Name:
Other - Last Name:HOUSE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APRN
Mailing Address - Street 1:3300 OAKDALE AVE N
Mailing Address - Street 2:
Mailing Address - City:ROBBINSDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55422-2926
Mailing Address - Country:US
Mailing Address - Phone:763-581-8900
Mailing Address - Fax:763-581-8901
Practice Address - Street 1:3300 OAKDALE AVE N
Practice Address - Street 2:
Practice Address - City:ROBBINSDALE
Practice Address - State:MN
Practice Address - Zip Code:55422-2926
Practice Address - Country:US
Practice Address - Phone:763-581-8900
Practice Address - Fax:763-581-8901
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-05
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5260363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health