Healthcare Provider Details

I. General information

NPI: 1457567679
Provider Name (Legal Business Name): BONNIE RAE LANKFORD RMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 GROS VENTRE AVE
HARLEM MT
59526
US

IV. Provider business mailing address

412 2ND AVE W BOX 87
DODSON MT
59524
US

V. Phone/Fax

Practice location:
  • Phone: 406-353-3100
  • Fax: 406-353-3229
Mailing address:
  • Phone: 406-383-4339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RM2200X
TaxonomyMedical Laboratory Technician
License Number584
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: