Healthcare Provider Details

I. General information

NPI: 1255256327
Provider Name (Legal Business Name): FALENE MARLENE RUSSETTE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
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

44 BEARCLAW ST
BOX ELDER MT
59521-8776
US

V. Phone/Fax

Practice location:
  • Phone: 406-395-4486
  • Fax:
Mailing address:
  • Phone: 406-301-4139
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License NumberAAA0000792922
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: