Healthcare Provider Details

I. General information

NPI: 1477585644
Provider Name (Legal Business Name): TIMOTHY JAMES KUROKAWA FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 09/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BOX 729
WOLF POINT MT
59201
US

IV. Provider business mailing address

550 6TH AVENUE NORTH
WOLF POINT MT
59201
US

V. Phone/Fax

Practice location:
  • Phone: 406-653-1641
  • Fax: 406-653-3728
Mailing address:
  • Phone: 406-653-1641
  • Fax: 406-653-3728

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN11344
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: