Healthcare Provider Details

I. General information

NPI: 1558872192
Provider Name (Legal Business Name): EMILY DOROTHEA STOPKA FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2017
Last Update Date: 03/01/2023
Certification Date: 03/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 10TH AVE S
GREAT FALLS MT
59405-4078
US

IV. Provider business mailing address

PO BOX 5515
PORTLAND OR
97228-5515
US

V. Phone/Fax

Practice location:
  • Phone: 406-430-1040
  • Fax: 406-430-1041
Mailing address:
  • Phone: 210-349-5577
  • Fax: 210-491-2819

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number149865
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: