Healthcare Provider Details

I. General information

NPI: 1144683475
Provider Name (Legal Business Name): CENTRAL MEDISPA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2016
Last Update Date: 08/10/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 S CENTRAL AVE
SIDNEY MT
59270-4127
US

IV. Provider business mailing address

309 S CENTRAL AVE
SIDNEY MT
59270-4127
US

V. Phone/Fax

Practice location:
  • Phone: 406-488-5000
  • Fax: 844-766-1639
Mailing address:
  • Phone: 406-488-5000
  • Fax: 844-766-1639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNUR APRN LIC 100657
License Number StateMT

VIII. Authorized Official

Name: MICHELLE L. FRANK
Title or Position: APRN/OWNER
Credential: APRN, CNP
Phone: 406-488-5000