Healthcare Provider Details

I. General information

NPI: 1336415884
Provider Name (Legal Business Name): JENNIFER LOUISE MORIGEAU RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2012
Last Update Date: 03/29/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 BITTERROOT JIM ROAD
ARLEE MT
59821
US

IV. Provider business mailing address

P.O. BOX 880
ST. IGNATIUS MT
59865
US

V. Phone/Fax

Practice location:
  • Phone: 406-726-3224
  • Fax: 406-726-4023
Mailing address:
  • Phone: 406-745-3525
  • Fax: 406-745-4233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number31517
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: