Healthcare Provider Details

I. General information

NPI: 1104657311
Provider Name (Legal Business Name): PAXTIN ROBERT MCCANN RN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2024
Last Update Date: 08/09/2024
Certification Date: 08/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ROCKY BOY HEALTH CENTER 6850 UPPER BOX ELDER RD
BOX ELDER MT
59521
US

IV. Provider business mailing address

40540 US HIGHWAY 2
CHINOOK MT
59523-9327
US

V. Phone/Fax

Practice location:
  • Phone: 406-395-4486
  • Fax:
Mailing address:
  • Phone: 406-262-0265
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberNUR-RN-LIC-239786
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: