Healthcare Provider Details

I. General information

NPI: 1588274575
Provider Name (Legal Business Name): PATRICIA HEIDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2020
Last Update Date: 08/04/2020
Certification Date: 08/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

669 AGENCY MAIN ST
HARLEM MT
59526-9455
US

IV. Provider business mailing address

669 AGENCY MAIN ST
HARLEM MT
59526-9455
US

V. Phone/Fax

Practice location:
  • Phone: 406-353-3100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number95026456
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: