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NPI Code Detail

MEDICARE: J FLAIR WELLNESS

MEDICARE: J FLAIR WELLNESS
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
1261Q00000XClinic/Center
2363LF0000XFamily Nurse Practitioner

General Provider Information

NPI Number : 1669187563
Entity Type Code : Organization
Provider Name (Legal Business Name) : J FLAIR WELLNESS
Provider Business Mailing Address
First Line : 1415 NORTHWEST BYP STE 2
Second Line :
City : GREAT FALLS
State : MT
Zip : 59404-1710
Country : US
Telephone Number : 406-788-6300
Fax Number :
Provider Business Practice Location Address
First Line : 1415 NORTHWEST BYP STE 2
Second Line :
City : GREAT FALLS
State : MT
Zip : 59404-1710
Country : US
Telephone Number : 406-788-6300
Fax Number :
Authorized Official
Title or Position : OWNER
Name : MRS. JACQUELINE COOKE
Credential :
Telephone Number : 406-788-6300
Provider Enumeration Date : 01/16/2023
Last Update Date : 04/21/2023

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