Healthcare Provider Details

I. General information

NPI: 1992125884
Provider Name (Legal Business Name): CHARLES BRATSKY R.N
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2014
Last Update Date: 04/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CHEYENNE AVE
LAME DEER MT
59043-0070
US

IV. Provider business mailing address

PO BOX 70 100 CHEYENNE AVE.
LAME DEER MT
59043-0070
US

V. Phone/Fax

Practice location:
  • Phone: 406-477-4400
  • Fax:
Mailing address:
  • Phone: 406-477-4400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN21041
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: