MEDICARE: MRS. KAYLEIGH MOLDENHAUER NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LG0600X	Gerontology Nurse Practitioner	125074	MT

General Provider Information

NPI Number	:	1376075309
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KAYLEIGH MOLDENHAUER NP

Provider Business Mailing Address
First Line	:	3687 VETERANS DR
Second Line	:
City	:	FORT HARRISON
State	:	MT
Zip	:	59636-1500
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3687 VETERANS DR.
Second Line	:
City	:	FORT HARRISON
State	:	MT
Zip	:	59636-1500
Country	:	US
Telephone Number	:	406-447-7680
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/29/2017
Last Update Date	:	03/29/2017

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