Healthcare Provider Details

I. General information

NPI: 1639436983
Provider Name (Legal Business Name): KATHLEEN HULETT RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2012
Last Update Date: 04/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3687 VETERAN'S DRIVE VA MEDICAL CENTER
FORT HARRISON MT
59636
US

IV. Provider business mailing address

1360 RANCHVIEW RD
HELENA MT
59602-9360
US

V. Phone/Fax

Practice location:
  • Phone: 406-442-6410
  • Fax:
Mailing address:
  • Phone: 406-458-7082
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number45388
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number101166
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: