Healthcare Provider Details

I. General information

NPI: 1760880066
Provider Name (Legal Business Name): CARLY JEAN HILLENBRAND APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CARLY JEAN MEEHAN RN

II. Dates (important events)

Enumeration Date: 12/18/2014
Last Update Date: 04/29/2024
Certification Date: 04/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 E 7TH ST STE 3A
ANACONDA MT
59711-2913
US

IV. Provider business mailing address

520 SPRUCE ST
ANACONDA MT
59711-2851
US

V. Phone/Fax

Practice location:
  • Phone: 406-209-7777
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberNUR-APRN-LIC-103904
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number47854
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: