Healthcare Provider Details

I. General information

NPI: 1659419778
Provider Name (Legal Business Name): TAMMY LYNN MATT RN BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 BITTERROOT JIM LANE
ARLEE MT
59821
US

IV. Provider business mailing address

PO BOX 880
ST IGNATIUS MT
59865-0880
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN23397
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: