Healthcare Provider Details

I. General information

NPI: 1356789598
Provider Name (Legal Business Name): HANNAH C CHAM-A-KOON R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: HANNAH C COWGILL R.D.

II. Dates (important events)

Enumeration Date: 06/10/2013
Last Update Date: 04/06/2020
Certification Date: 04/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 26TH ST S
GREAT FALLS MT
59405-5161
US

IV. Provider business mailing address

232 SALEM RD
GREAT FALLS MT
59405-8053
US

V. Phone/Fax

Practice location:
  • Phone: 406-455-5000
  • Fax: 406-455-4965
Mailing address:
  • Phone: 406-396-6556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number19358
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: