Healthcare Provider Details

I. General information

NPI: 1336124072
Provider Name (Legal Business Name): PENNY LYNN STARKEL NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PENNY L CHARRANCE

II. Dates (important events)

Enumeration Date: 12/14/2005
Last Update Date: 08/17/2023
Certification Date: 08/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 13TH AVE E
POLSON MT
59860-5315
US

IV. Provider business mailing address

PO BOX 12
LIBERTY LAKE WA
99019-0012
US

V. Phone/Fax

Practice location:
  • Phone: 406-883-5377
  • Fax: 406-883-8254
Mailing address:
  • Phone: 866-747-2455
  • Fax: 406-329-2659

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNUR-APRN-LIC-100584
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number059023-23
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: