Healthcare Provider Details

I. General information

NPI: 1023496841
Provider Name (Legal Business Name): LEE BAIDINGER FENWICK CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2015
Last Update Date: 03/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 S CLARK ST
BUTTE MT
59701-2328
US

IV. Provider business mailing address

1118 ANTIMONY ST
BUTTE MT
59701-8706
US

V. Phone/Fax

Practice location:
  • Phone: 406-723-2500
  • Fax:
Mailing address:
  • Phone: 928-380-1831
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberCRNA1148
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number97473
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: