Healthcare Provider Details

I. General information

NPI: 1811332000
Provider Name (Legal Business Name): CARRIE ELIZABETH CORBETT L.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2013
Last Update Date: 05/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

494 N MAIN ST
KALISPELL MT
59901-3948
US

IV. Provider business mailing address

532 BLAINE VIEW LN
KALISPELL MT
59901-7620
US

V. Phone/Fax

Practice location:
  • Phone: 406-260-5105
  • Fax: 406-206-0215
Mailing address:
  • Phone: 406-257-5366
  • Fax: 406-206-0215

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberAHC-MID-LIC-865
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: