Healthcare Provider Details

I. General information

NPI: 1760822043
Provider Name (Legal Business Name): ALACEA L HEAD RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2013
Last Update Date: 07/01/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 34TH ST APT 6E
MISSOULA MT
59801-8572
US

IV. Provider business mailing address

1150 34TH ST APT 6E
MISSOULA MT
59801-8572
US

V. Phone/Fax

Practice location:
  • Phone: 907-888-4524
  • Fax: 307-332-0131
Mailing address:
  • Phone: 907-888-4524
  • Fax: 307-332-0131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberNUR-RN-LIC-59335
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: