Healthcare Provider Details

I. General information

NPI: 1255384251
Provider Name (Legal Business Name): LARAYNE K OLTZ CRMA
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: LORI K OLTZ CRNA

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 SUNNYVIEW LN
KALISPELL MT
59901-3129
US

IV. Provider business mailing address

202 CONWAY DR SUITE 100
KALISPELL MT
59901-3112
US

V. Phone/Fax

Practice location:
  • Phone: 406-751-7695
  • Fax: 406-755-0971
Mailing address:
  • Phone: 406-751-5662
  • Fax: 406-755-0971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN7600
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: