Healthcare Provider Details

I. General information

NPI: 1760914287
Provider Name (Legal Business Name): SUNNY MARY WHITEMAN-GRANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUNNY MARY WHITEMAN

II. Dates (important events)

Enumeration Date: 04/03/2017
Last Update Date: 02/03/2026
Certification Date: 02/03/2026
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

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

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number104320
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: