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NPI Code Detail

MEDICARE: TARA JANE WILLOUGHBY APRN

MEDICARE: TARA JANE WILLOUGHBY APRN
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
1363LF0000XFamily Nurse Practitioner142868MT
2363LP0808XPsychiatric/Mental Health Nurse Practitioner142868MT

General Provider Information

NPI Number : 1487207122
Entity Type Code : Individual
Provider Name (Legal Business Name) : TARA JANE WILLOUGHBY APRN
Provider Business Mailing Address
First Line : 1321 WYOMING ST
Second Line :
City : MISSOULA
State : MT
Zip : 59801-1725
Country : US
Telephone Number : 406-532-8400
Fax Number : 406-224-4402
Provider Business Practice Location Address
First Line : 81 W PARK ST
Second Line :
City : BUTTE
State : MT
Zip : 59701-1713
Country : US
Telephone Number : 406-497-9000
Fax Number : 406-723-7117
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/22/2019
Last Update Date : 07/22/2019

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