Healthcare Provider Details

I. General information

NPI: 1235287251
Provider Name (Legal Business Name): LOWELL WILLIAM MEDHUS FNP,PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 01/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 6TH AVE N
WOLF POINT MT
59201-0729
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 TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN19426
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: