| NPI | 1285935924 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CODA E REYNOLDS Fnp 406-723-0123 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization (Licence: MT 7628) |
| Additional Taxonomies | 363LF0000X Nurse Practitioner, Family (Licence: MT 33467) |
| Enumeration Date | 2010-11-11 |
| Last Update Date | 2011-10-17 |