Healthcare Provider Details

I. General information

NPI: 1437475985
Provider Name (Legal Business Name): MARDELL KAY RAILE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/08/2010
Last Update Date: 04/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CHEYENNE AVE
LAME DEER MT
59043
US

IV. Provider business mailing address

100 CHEYENNE AVE
LAME DEER MT
59043
US

V. Phone/Fax

Practice location:
  • Phone: 406-477-4484
  • Fax:
Mailing address:
  • Phone: 406-477-4484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN32541
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: