Healthcare Provider Details

I. General information

NPI: 1528171980
Provider Name (Legal Business Name): DANETTE A MCINTYRE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 02/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 KNAPP ST
WOLF POINT MT
59201-1826
US

IV. Provider business mailing address

301 KNAPP ST
WOLF POINT MT
59201-1826
US

V. Phone/Fax

Practice location:
  • Phone: 406-653-2150
  • Fax: 406-653-6591
Mailing address:
  • Phone: 406-653-2150
  • Fax: 406-653-6591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberRN15828
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: