Provider Demographics
NPI:1336571942
Name:VON BARGEN, ELIZABETH L (NP)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:L
Last Name:VON BARGEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 472
Mailing Address - Street 2:
Mailing Address - City:CRAIGMONT
Mailing Address - State:ID
Mailing Address - Zip Code:83523-0472
Mailing Address - Country:US
Mailing Address - Phone:208-791-6183
Mailing Address - Fax:949-404-8139
Practice Address - Street 1:816 MAIN ST
Practice Address - Street 2:
Practice Address - City:LEWISTON
Practice Address - State:ID
Practice Address - Zip Code:83501-1838
Practice Address - Country:US
Practice Address - Phone:208-791-6183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-06
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDNP-1297A363LP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health