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NPI Code Detail

MEDICARE: SHELLEY DAWN DUGAN

MEDICARE: SHELLEY DAWN DUGAN
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
1363AM0700XMedical Physician Assistant390MT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1922089705
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHELLEY DAWN DUGAN
Provider Business Mailing Address
First Line : 350 HERITAGE WAY STE 2100
Second Line :
City : KALISPELL
State : MT
Zip : 59901-3167
Country : US
Telephone Number : 406-257-8992
Fax Number : 406-257-8996
Provider Business Practice Location Address
First Line : 350 HERITAGE WAY STE 2100
Second Line :
City : KALISPELL
State : MT
Zip : 59901-3167
Country : US
Telephone Number : 406-257-8992
Fax Number : 406-257-8996
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/09/2005
Last Update Date : 11/27/2023

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Directions to “ SHELLEY DAWN DUGAN ” Practice Location

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