Healthcare Provider Details

I. General information

NPI: 1497964605
Provider Name (Legal Business Name): MRS. SHARON MARIE MCEWEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2598 CASPER DR
EAST HELENA MT
59635-3451
US

IV. Provider business mailing address

2598 CASPER DR
EAST HELENA MT
59635-3451
US

V. Phone/Fax

Practice location:
  • Phone: 406-458-5535
  • Fax: 406-458-5535
Mailing address:
  • Phone: 406-458-5535
  • Fax: 406-458-5535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number0034010001
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: