Provider Demographics
NPI:1477240471
Name:THOM, LIZBETH J (CNP)
Entity type:Individual
Prefix:
First Name:LIZBETH
Middle Name:J
Last Name:THOM
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 E MINERS DR
Mailing Address - Street 2:
Mailing Address - City:ELY
Mailing Address - State:MN
Mailing Address - Zip Code:55731-1400
Mailing Address - Country:US
Mailing Address - Phone:218-248-0122
Mailing Address - Fax:218-365-0005
Practice Address - Street 1:720 E MINERS DR
Practice Address - Street 2:
Practice Address - City:ELY
Practice Address - State:MN
Practice Address - Zip Code:55731-1400
Practice Address - Country:US
Practice Address - Phone:218-365-0001
Practice Address - Fax:218-365-0005
Is Sole Proprietor?:No
Enumeration Date:2023-04-19
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9977363LA2200X, 363LF0000X, 363LP2300X, 363LW0102X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health