Healthcare Provider Details

I. General information

NPI: 1730237876
Provider Name (Legal Business Name): SALLY ANN LYDON CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 02/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 4TH ST S
GREAT FALLS MT
59401-3618
US

IV. Provider business mailing address

770 SPRING CREEK RD
SAND COULEE MT
59472-9749
US

V. Phone/Fax

Practice location:
  • Phone: 406-454-6973
  • Fax: 406-454-6986
Mailing address:
  • Phone: 406-736-5797
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN20118
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberRN20118
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: