Healthcare Provider Details

I. General information

NPI: 1801054945
Provider Name (Legal Business Name): BECKY ANN PETRASHEK RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2008
Last Update Date: 05/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 SUNNYVIEW LN
KALISPELL MT
59901-3129
US

IV. Provider business mailing address

1241 8TH AVE E
KALISPELL MT
59901-5874
US

V. Phone/Fax

Practice location:
  • Phone: 406-752-5111
  • Fax:
Mailing address:
  • Phone: 406-257-5889
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License NumberRN10782
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: