Healthcare Provider Details

I. General information

NPI: 1003867037
Provider Name (Legal Business Name): JENNIE WALKER ECKSTROM M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JENNIE KAY WALKER

II. Dates (important events)

Enumeration Date: 05/15/2006
Last Update Date: 05/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 BAKER AVE GLACIER MEDICAL ASSOCIATES
WHITEFISH MT
59937-2901
US

IV. Provider business mailing address

1111 BAKER AVE GLACIER MEDICAL ASSOCIATES
WHITEFISH MT
59937-2901
US

V. Phone/Fax

Practice location:
  • Phone: 406-862-2515
  • Fax: 406-862-4229
Mailing address:
  • Phone: 406-862-2515
  • Fax: 406-862-4229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberM9143
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number10784
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: