Healthcare Provider Details

I. General information

NPI: 1992178701
Provider Name (Legal Business Name): DODI YVONNE HURD MT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: DODI YVONNE SMITH MT

II. Dates (important events)

Enumeration Date: 11/03/2015
Last Update Date: 11/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4449 PINE COVE RD
BILLINGS MT
59106-1334
US

IV. Provider business mailing address

4449 PINE COVE RD
BILLINGS MT
59106-1334
US

V. Phone/Fax

Practice location:
  • Phone: 406-690-8181
  • Fax:
Mailing address:
  • Phone: 406-690-8181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberLMT-LMT-LIC-7903
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: