Provider Demographics
NPI:1215135348
Name:O'NEILL, ELIZABETH ANN (MS ARNP-BC)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:ANN
Last Name:O'NEILL
Suffix:
Gender:F
Credentials:MS ARNP-BC
Other - Prefix:MRS
Other - First Name:ELIZABETH
Other - Middle Name:ANN
Other - Last Name:HARDEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1000 E 23RD ST
Mailing Address - Street 2:SUITE #230
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-2108
Mailing Address - Country:US
Mailing Address - Phone:605-322-7334
Mailing Address - Fax:605-322-6738
Practice Address - Street 1:1000 E 23RD ST
Practice Address - Street 2:SUITE #230
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-2108
Practice Address - Country:US
Practice Address - Phone:605-322-7334
Practice Address - Fax:605-322-6738
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2015-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCP000514363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD6833380Medicaid
SDS104408Medicare PIN