Healthcare Provider Details

I. General information

NPI: 1851640767
Provider Name (Legal Business Name): CHARLENE LAURA WARD FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHARLENE LAURA MOORE

II. Dates (important events)

Enumeration Date: 09/06/2012
Last Update Date: 03/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

935 HIGHLAND BLVD STE 2180
BOZEMAN MT
59715
US

IV. Provider business mailing address

935 HIGHLAND BLVD STE 2180
BOZEMAN MT
59715-6904
US

V. Phone/Fax

Practice location:
  • Phone: 406-414-5512
  • Fax:
Mailing address:
  • Phone: 406-414-5512
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number100933
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code364SC1501X
TaxonomyCommunity Health/Public Health Clinical Nurse Specialist
License NumberNUR-RN-LIC-47637
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: