Healthcare Provider Details

I. General information

NPI: 1194038190
Provider Name (Legal Business Name): SALVIA ACOSTA HARRIS LMP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SALVIA SHERMAN MAKEE SALVIA SHERMAN MAKEE

II. Dates (important events)

Enumeration Date: 07/19/2010
Last Update Date: 12/03/2024
Certification Date: 12/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 US HIGHWAY 10 W
LIVINGSTON MT
59047-9022
US

IV. Provider business mailing address

1201 US HIGHWAY 10 W STE A1
LIVINGSTON MT
59047-9022
US

V. Phone/Fax

Practice location:
  • Phone: 406-272-5270
  • Fax:
Mailing address:
  • Phone: 406-272-5270
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License NumberLMT-LMT-LIC-11837
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: