Healthcare Provider Details

I. General information

NPI: 1376523332
Provider Name (Legal Business Name): CHRISTINE MARIE MCCUTCHEON APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 10/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3687 VETERANS DR
FORT HARRISON MT
59636-9703
US

IV. Provider business mailing address

3687 VETERANS DR
FT HARRISON MT
59636-1500
US

V. Phone/Fax

Practice location:
  • Phone: 406-442-6410
  • Fax: 406-442-6410
Mailing address:
  • Phone: 843-228-5577
  • Fax: 843-228-5196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number78586
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: