Healthcare Provider Details

I. General information

NPI: 1073114872
Provider Name (Legal Business Name): HAROLD JAMES HORINE III DNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2020
Last Update Date: 10/01/2021
Certification Date: 10/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 CENTENNIAL AVE
BUTTE MT
59701-2870
US

IV. Provider business mailing address

43 MEADOW LARK LN
DEER LODGE MT
59722-9540
US

V. Phone/Fax

Practice location:
  • Phone: 406-723-4075
  • Fax:
Mailing address:
  • Phone: 406-490-9391
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number163627
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: