Healthcare Provider Details

I. General information

NPI: 1689431413
Provider Name (Legal Business Name): HANNAH RANAE MCENDREE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2024
Last Update Date: 06/22/2025
Certification Date: 06/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

383 N 17TH AVE
FORSYTH MT
59327-7971
US

IV. Provider business mailing address

807 36TH ST
CODY WY
82414-8416
US

V. Phone/Fax

Practice location:
  • Phone: 406-346-2161
  • Fax:
Mailing address:
  • Phone: 307-388-0126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number160469
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: