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NPI Code Detail

MEDICARE: MAE O BERENTSON NP

MEDICARE: MAE O BERENTSON 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
1363L00000XNurse PractitionerRN26212MT
2363L00000XNurse Practitioner100419MT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
21972558120OTHERMTBCBS

General Provider Information

NPI Number : 1972558120
Entity Type Code : Individual
Provider Name (Legal Business Name) : MAE O BERENTSON NP
Provider Business Mailing Address
First Line : 160 HERITAGE WAY STE 202
Second Line :
City : KALISPELL
State : MT
Zip : 59901-3127
Country : US
Telephone Number : 406-752-8433
Fax Number : 406-756-6768
Provider Business Practice Location Address
First Line : 160 HERITAGE WAY STE 202
Second Line :
City : KALISPELL
State : MT
Zip : 59901-3127
Country : US
Telephone Number : 406-752-8433
Fax Number : 406-756-6768
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/24/2006
Last Update Date : 11/27/2023

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Directions to “ MAE O BERENTSON NP” Practice Location

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