Healthcare Provider Details

I. General information

NPI: 1710625660
Provider Name (Legal Business Name): LAURA DRAKE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2022
Last Update Date: 05/21/2022
Certification Date: 05/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 N 9TH ST
HAMILTON MT
59840-2326
US

IV. Provider business mailing address

580 HARMONY WAY
HAMILTON MT
59840-9636
US

V. Phone/Fax

Practice location:
  • Phone: 406-363-9028
  • Fax:
Mailing address:
  • Phone: 201-615-8409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberNUR-RN-LIC-161972
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: