Provider Demographics
NPI:1205445871
Name:HALVERSON, ELIZABETH (CRNA)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:HALVERSON
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:ELLIE
Other - Middle Name:
Other - Last Name:HALVERSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:26868 468TH AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57106-8017
Mailing Address - Country:US
Mailing Address - Phone:612-716-5984
Mailing Address - Fax:
Practice Address - Street 1:1305 W 18TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-0401
Practice Address - Country:US
Practice Address - Phone:605-333-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-29
Last Update Date:2020-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCR001053367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered