Healthcare Provider Details

I. General information

NPI: 1598418626
Provider Name (Legal Business Name): CODY ALAN RUMMEL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2022
Last Update Date: 07/02/2023
Certification Date: 06/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 N MONTANA AVE # 3856
HELENA MT
59601-4185
US

IV. Provider business mailing address

820 N MONTANA AVE # 3856
HELENA MT
59601-4185
US

V. Phone/Fax

Practice location:
  • Phone: 406-443-7733
  • Fax:
Mailing address:
  • Phone: 406-443-7733
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNUR-APRN-LIC-216822
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberNUR-RN-LIC-102002
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: