Healthcare Provider Details

I. General information

NPI: 1700795341
Provider Name (Legal Business Name): TAMMY VANDERWOUDE APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 W BROADWAY ST STE 320
MISSOULA MT
59802-4008
US

IV. Provider business mailing address

1580 FOX FIELD DR
MISSOULA MT
59802-8605
US

V. Phone/Fax

Practice location:
  • Phone: 406-329-5615
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNUR-APRN-LIC-292995
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: