Healthcare Provider Details

I. General information

NPI: 1467531871
Provider Name (Legal Business Name): REGINA HULTIN RD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2006
Last Update Date: 05/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1930 9TH AVE
HELENA MT
59601-4759
US

IV. Provider business mailing address

1930 9TH AVE
HELENA MT
59601-4759
US

V. Phone/Fax

Practice location:
  • Phone: 406-457-8958
  • Fax: 406-457-8990
Mailing address:
  • Phone: 406-457-8958
  • Fax: 406-457-8990

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number484
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: