Healthcare Provider Details

I. General information

NPI: 1124031786
Provider Name (Legal Business Name): ERNESTO E. ORNELAS FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 12/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1208 6TH AVE
SUPERIOR MT
59872-9618
US

IV. Provider business mailing address

1208 6TH AVE P.O. BOX 698
SUPERIOR MT
59872-9618
US

V. Phone/Fax

Practice location:
  • Phone: 406-822-4278
  • Fax: 406-822-4912
Mailing address:
  • Phone: 406-822-4278
  • Fax: 406-822-4912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number25639
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: