Healthcare Provider Details

I. General information

NPI: 1114405487
Provider Name (Legal Business Name): JANET NORDRUM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/30/2018
Last Update Date: 07/30/2018
Certification Date:
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

1325 IKE AVE
HAVRE MT
59501-5137
US

V. Phone/Fax

Practice location:
  • Phone: 406-395-1656
  • Fax:
Mailing address:
  • Phone: 406-262-4537
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number12679
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: