Healthcare Provider Details

I. General information

NPI: 1154953982
Provider Name (Legal Business Name): MAY VICTOR APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/10/2020
Last Update Date: 04/01/2021
Certification Date: 04/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 CEDAR ST
MISSOULA MT
59802-3911
US

IV. Provider business mailing address

1120 CEDAR ST
MISSOULA MT
59802-3911
US

V. Phone/Fax

Practice location:
  • Phone: 406-541-4673
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP144387
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberNUR-APRN-LIC-174154
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: