Healthcare Provider Details

I. General information

NPI: 1497828768
Provider Name (Legal Business Name): MARTHA BURTON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

#1 CHEYENNE AVENUE LAME DEER CLINIC
LAME DEER MT
59043-0070
US

IV. Provider business mailing address

PO BOX 70
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 Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR46131
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: