Healthcare Provider Details

I. General information

NPI: 1922214345
Provider Name (Legal Business Name): HAROLD JEANOTTE PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 AVENUE CHEYENNE BOX 70
LAME DEER MT
59043
US

IV. Provider business mailing address

RR 1 BOX 127A
SILESIA MT
59041-9709
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number296
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: