Healthcare Provider Details

I. General information

NPI: 1669643243
Provider Name (Legal Business Name): TOMINA KINZIE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2008
Last Update Date: 03/21/2008
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

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 Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN23754
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: