| NPI | 1861511669 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TINA RANDALL Administrator 406-497-5001 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LW0102X Nurse Practitioner, Women's Health (Licence: MT RN11730) |
| Enumeration Date | 2007-03-29 |
| Last Update Date | 2020-02-13 |