Healthcare Provider Details

I. General information

NPI: 1487677852
Provider Name (Legal Business Name): PAULETTE DENISE LASSITER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 04/02/2020
Certification Date: 04/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 DILWORTH ST
GLENDIVE MT
59330-2053
US

IV. Provider business mailing address

107 DILWORTH ST
GLENDIVE MT
59330-2053
US

V. Phone/Fax

Practice location:
  • Phone: 406-345-8901
  • Fax: 406-345-2655
Mailing address:
  • Phone: 406-345-8901
  • Fax: 406-345-2655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number70405
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: