Healthcare Provider Details

I. General information

NPI: 1821196387
Provider Name (Legal Business Name): JEAN HIGGINS PERETTO PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 02/28/2022
Certification Date: 02/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 N 3RD ST
HAMILTON MT
59840-2480
US

IV. Provider business mailing address

316 N 3RD ST
HAMILTON MT
59840-2480
US

V. Phone/Fax

Practice location:
  • Phone: 406-541-0032
  • Fax: 406-541-0036
Mailing address:
  • Phone: 406-541-0032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number278
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: