Healthcare Provider Details

I. General information

NPI: 1710069737
Provider Name (Legal Business Name): MICHAEL J MCCORMICK NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 03/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

760 HOSPITAL CIRCLE
BROWNING MT
59417
US

IV. Provider business mailing address

760 HOSPITAL CIRCLE
BROWNING MT
59417
US

V. Phone/Fax

Practice location:
  • Phone: 406-338-6138
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN14978
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: