Healthcare Provider Details

I. General information

NPI: 1144928748
Provider Name (Legal Business Name): MICHELE MATHEWS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2023
Last Update Date: 02/22/2023
Certification Date: 02/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 S ORANGE ST
MISSOULA MT
59801-1810
US

IV. Provider business mailing address

317 S ORANGE ST
MISSOULA MT
59801-1810
US

V. Phone/Fax

Practice location:
  • Phone: 406-549-1951
  • Fax: 406-542-5682
Mailing address:
  • Phone: 406-549-1951
  • Fax: 406-542-5682

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code237700000X
TaxonomyHearing Instrument Specialist
License NumberHAD-HAD-LIC-1823
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: