Healthcare Provider Details

I. General information

NPI: 1134798044
Provider Name (Legal Business Name): JESSICA ERIN ANTISDEL CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA ERIN PALMER RN

II. Dates (important events)

Enumeration Date: 06/24/2021
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 WESTWOOD DR
HAMILTON MT
59840-2345
US

IV. Provider business mailing address

1224 W MAIN ST
HAMILTON MT
59840-2338
US

V. Phone/Fax

Practice location:
  • Phone: 406-363-2211
  • Fax:
Mailing address:
  • Phone: 406-363-2211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number176478
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: