Healthcare Provider Details

I. General information

NPI: 1619009719
Provider Name (Legal Business Name): AMY GLORIA HAYNES ND LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 S 2ND ST W
MISSOULA MT
59801
US

IV. Provider business mailing address

521 S 2ND ST W
MISSOULA MT
59801
US

V. Phone/Fax

Practice location:
  • Phone: 406-721-2147
  • Fax: 406-728-0978
Mailing address:
  • Phone: 406-721-2147
  • Fax: 406-728-0978

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number32
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code175F00000X
TaxonomyNaturopath
License Number39
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: