Healthcare Provider Details

I. General information

NPI: 1386073716
Provider Name (Legal Business Name): ANNA M DANZ WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/06/2013
Last Update Date: 10/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13526 CRESCENT MOON DR
BIGFORK MT
59911-6091
US

IV. Provider business mailing address

1035 1ST AVE W
KALISPELL MT
59901-5607
US

V. Phone/Fax

Practice location:
  • Phone: 218-779-7623
  • Fax:
Mailing address:
  • Phone: 406-751-8113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number728514
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number124787
License Number StateMT
# 3
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberNUR-APRN-LIC-124787
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: