Healthcare Provider Details

I. General information

NPI: 1891966420
Provider Name (Legal Business Name): LOIS ELESE FLEMING RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2008
Last Update Date: 01/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 6TH AVENUE NORTH
WOLF POINT MT
59201
US

IV. Provider business mailing address

PO BOX 67
POPLAR MT
59255-0067
US

V. Phone/Fax

Practice location:
  • Phone: 406-653-1641
  • Fax: 406-653-3728
Mailing address:
  • Phone: 406-768-3491
  • Fax: 406-768-3603

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN8569
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: