Healthcare Provider Details

I. General information

NPI: 1427758135
Provider Name (Legal Business Name): LISA MARIE PRINCIPE FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2023
Last Update Date: 05/03/2023
Certification Date: 05/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 12TH AVE N STE 140W
BILLINGS MT
59101-7507
US

IV. Provider business mailing address

6315 VICTORIA LN
BILLINGS MT
59106-3201
US

V. Phone/Fax

Practice location:
  • Phone: 406-237-5050
  • Fax:
Mailing address:
  • Phone: 406-855-0871
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number213255
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberNUR-APRN-LIC-213255
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: