| NPI | 1255992129 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHAUNDRA STODDARD Billing Specialist 406-925-0985 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Enumeration Date | 2019-06-21 |
| Last Update Date | 2019-08-15 |