| NPI | 1134788185 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | STEPHEN GUY LOOSLI Executive Director 406-763-8833 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208000000X Pediatrics |
| Additional Taxonomies | 261QP2300X Clinic/Center, Primary Care |
| 363LP0200X Nurse Practitioner, Pediatrics | |
| Enumeration Date | 2019-06-12 |
| Last Update Date | 2020-08-10 |