Healthcare Provider Details

I. General information

NPI: 1619385986
Provider Name (Legal Business Name): BECKY J CLIZBE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2014
Last Update Date: 07/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

71972 BITTERROOT JIM RD.
ARLEE MT
59821
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 406-745-3525
  • Fax: 406-745-3529
Mailing address:
  • Phone: 406-745-3525
  • Fax: 406-745-3529

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNUR-RN-LIC-31509
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code364SF0001X
TaxonomyFamily Health Clinical Nurse Specialist
License NumberNUR-RN-LIC-31509
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: