Healthcare Provider Details

I. General information

NPI: 1689361131
Provider Name (Legal Business Name): MESA SPRING MENG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2023
Last Update Date: 08/07/2024
Certification Date: 08/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 S SANSOME ST
PHILIPSBURG MT
59858-7711
US

IV. Provider business mailing address

310 S SANSOME ST
PHILIPSBURG MT
59858-7711
US

V. Phone/Fax

Practice location:
  • Phone: 406-589-3271
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License Number10219019-3102
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNUR-APRN-LIC-241286
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: