SOPHIA RAELYN VIVANT

MISSOULA, MT
NPI1912675216
Former NameSOPHIA PETERSON
Entity TypeIndividual
GenderFemale
Sole Proprietor ?No
Primary Taxonomy363A00000X Physician Assistant
(Licence: MT  129044)
Enumeration Date2021-09-01
Last Update Date2024-09-18
Business Address
SOPHIA RAELYN VIVANT PA-C
700 W KENT AVE
MISSOULA, MT 59801-6772
Phone number: 406-541-3277
Mailing Address
SOPHIA RAELYN VIVANT PA-C
700 W KENT AVE
MISSOULA, MT 59801-6772
Phone number: 406-541-3277
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