Healthcare Provider Details

I. General information

NPI: 1205751146
Provider Name (Legal Business Name): RUTH LYNN FOUR SOULS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RUTH LYNN DURAN

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6850 UPPER BOX ELDER RD
BOX ELDER MT
59521-9073
US

IV. Provider business mailing address

81 MEADOWBROOK RD
BOX ELDER MT
59521-8720
US

V. Phone/Fax

Practice location:
  • Phone: 406-395-4486
  • Fax:
Mailing address:
  • Phone: 406-399-0160
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License NumberAAB0000441065
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: