Healthcare Provider Details

I. General information

NPI: 1831020825
Provider Name (Legal Business Name): COURTNEY L FUNDERBURK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 5TH AVE STE B
HAVRE MT
59501-4015
US

IV. Provider business mailing address

84 20TH ST
HAVRE MT
59501-5260
US

V. Phone/Fax

Practice location:
  • Phone: 406-201-5193
  • Fax: 406-403-0281
Mailing address:
  • Phone: 406-201-5193
  • Fax: 406-201-5193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: COURTNEY FUNDERBURK
Title or Position: OWNER/OPERATOR/PROVIDER
Credential:
Phone: 406-201-5193