Healthcare Provider Details

I. General information

NPI: 1467995928
Provider Name (Legal Business Name): SARAH SLATER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2016
Last Update Date: 11/10/2021
Certification Date: 11/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 W SPRUCE ST STE J
MISSOULA MT
59802-4047
US

IV. Provider business mailing address

PO BOX 12
LIBERTY LAKE WA
99019-0012
US

V. Phone/Fax

Practice location:
  • Phone: 406-327-3350
  • Fax: 406-327-3355
Mailing address:
  • Phone: 406-327-3350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number158290
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNUR-APRN-LIC-158290
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: