Provider Demographics
NPI:1982637310
Name:CHILTON, ELIZABETH W (ARNP)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:W
Last Name:CHILTON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1021 NEBRASKA ST
Mailing Address - Street 2:P.O. BOX 5410
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51105-1436
Mailing Address - Country:US
Mailing Address - Phone:712-252-2477
Mailing Address - Fax:712-252-5516
Practice Address - Street 1:1021 NEBRASKA ST
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51104-5410
Practice Address - Country:US
Practice Address - Phone:712-252-2477
Practice Address - Fax:712-252-5516
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCP000243363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6827970Medicaid
IA39751OtherWELLMARK
IA0474254Medicaid
SD4994586OtherWELLMARK
IAI15341Medicare ID - Type Unspecified
IAS66856Medicare UPIN
IA0474254Medicaid