Healthcare Provider Details

I. General information

NPI: 1528125390
Provider Name (Legal Business Name): DOROTHY MCBRIDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 08/09/2012
Certification Date:
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:
Mailing address:
  • Phone: 406-283-6900
  • Fax: 406-293-6622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberRN10803
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number10803
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: