Healthcare Provider Details

I. General information

NPI: 1891545547
Provider Name (Legal Business Name): P SHARISE CLOSTIO, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2024
Last Update Date: 03/25/2024
Certification Date: 03/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

429 1ST ST W
KALISPELL MT
59901-4407
US

IV. Provider business mailing address

429 1ST ST W
KALISPELL MT
59901-4407
US

V. Phone/Fax

Practice location:
  • Phone: 406-871-0200
  • Fax:
Mailing address:
  • Phone: 406-871-0200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number
License Number State

VIII. Authorized Official

Name: PAMELA SHARISE CLOSTIO
Title or Position: OWNER
Credential: APRN
Phone: 406-871-0200