Healthcare Provider Details

I. General information

NPI: 1841376639
Provider Name (Legal Business Name): LAUREL HELENE DESNICK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 03/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 RIVER DR
LIVINGSTON MT
59047-3716
US

IV. Provider business mailing address

504 S 13TH ST
LIVINGSTON MT
59047-3727
US

V. Phone/Fax

Practice location:
  • Phone: 406-222-0800
  • Fax: 406-222-7606
Mailing address:
  • Phone: 406-823-6414
  • Fax: 406-823-6287

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD00036360
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number620316
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: