Healthcare Provider Details

I. General information

NPI: 1437376134
Provider Name (Legal Business Name): LIANNA MARY DANIELSON FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2007
Last Update Date: 03/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

191 JEWELL BASIN CT SUITE 2A
BIGFORK MT
59911-6290
US

IV. Provider business mailing address

415 LAKE LOOP DR
KALISPELL MT
59901-8705
US

V. Phone/Fax

Practice location:
  • Phone: 406-837-4357
  • Fax: 406-837-3957
Mailing address:
  • Phone: 406-257-5881
  • Fax: 406-257-5881

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number29924
License Number StateMT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: