Healthcare Provider Details

I. General information

NPI: 1831716927
Provider Name (Legal Business Name): CHLOE MARIE GEORGETON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2020
Last Update Date: 07/06/2020
Certification Date: 07/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1288 N 14TH AVE STE 201
BOZEMAN MT
59715-8535
US

IV. Provider business mailing address

210 N CHURCH AVE
BOZEMAN MT
59715-3706
US

V. Phone/Fax

Practice location:
  • Phone: 406-587-0681
  • Fax:
Mailing address:
  • Phone: 406-600-8921
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number160100
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: