Healthcare Provider Details

I. General information

NPI: 1619419405
Provider Name (Legal Business Name): ERIN FLAVIN PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2016
Last Update Date: 08/21/2024
Certification Date: 08/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 E 2ND ST
LIBBY MT
59923-2010
US

IV. Provider business mailing address

320 E 2ND ST
LIBBY MT
59923-2010
US

V. Phone/Fax

Practice location:
  • Phone: 406-283-6900
  • Fax: 406-293-6622
Mailing address:
  • Phone: 406-283-6900
  • Fax: 406-293-6622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberNUR-APRN-LIC-105076
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: