Healthcare Provider Details

I. General information

NPI: 1972973477
Provider Name (Legal Business Name): THERESA OHL FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2015
Last Update Date: 09/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

311 S 8TH AVE E 311 S. 8TH AVE E
MALTA MT
59538-8978
US

IV. Provider business mailing address

311 S 8TH AVE E PO BOX 640
MALTA MT
59538-8978
US

V. Phone/Fax

Practice location:
  • Phone: 406-654-1800
  • Fax: 406-654-2876
Mailing address:
  • Phone: 406-654-1800
  • Fax: 406-654-2876

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNUR-RN-LIC-28429
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: