Healthcare Provider Details

I. General information

NPI: 1124073341
Provider Name (Legal Business Name): YVONNE K COURCHESNE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 11/12/2024
Certification Date: 11/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1037 MAIN ST
CORVALLIS MT
59828-9004
US

IV. Provider business mailing address

1200 WESTWOOD DR
HAMILTON MT
59840-2345
US

V. Phone/Fax

Practice location:
  • Phone: 406-961-4661
  • Fax: 406-961-4260
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMED-PHYS-LIC-10225
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: