Individual
ELIZABETH A WIBORG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN CNP
Contact information
Practice address
2450 26TH AVE S, MINNEAPOLIS, MN 55406-1245
(612) 721-2491
Mailing address
7755 CENTER AVE, STE 630, HUNTINGTON BEACH, CA 92647-9152
(657) 400-5180
Taxonomy
Speciality
Code
Description
License number
State
363LG0600X
Gerontology Nurse Practitioner
Primary
CNP 2753
MN
363LG0600X
Gerontology Nurse Practitioner
R 94784-6
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
504536600
—
MN
Enumeration date
03/21/2006
Last updated
01/08/2020
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