Healthcare Provider Details

I. General information

NPI: 1962940460
Provider Name (Legal Business Name): LISA TURK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2017
Last Update Date: 02/19/2024
Certification Date: 02/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 BOE LN
WHITEHALL MT
59759-9702
US

IV. Provider business mailing address

48 BOE LN
WHITEHALL MT
59759-9702
US

V. Phone/Fax

Practice location:
  • Phone: 406-498-6183
  • Fax: 406-782-4020
Mailing address:
  • Phone: 406-498-6183
  • Fax: 406-782-4020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number124046
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: