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General NPI Number Information
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NPI Number | 1003067182
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Entity Type | Organization
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Legal Business Name | ST. PATRICK HOSPITAL AND HEALTH SCIENCES CENTER
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Dates
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Enumeration Date | 10/07/2008
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Last Update Date | 05/06/2025
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Provider Practice Location Address
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Address Line | 500 W BROADWAY ST # LEVEL3
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City | MISSOULA
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State | MT
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Zip | 59802-4008
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Country | US
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Telephone | 406-327-3057
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Fax | 406-327-3231
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Provider Business Mailing Address
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Address Line | 500 W BROADWAY LEVEL 3
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City | MISSOULA
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State | MT
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Zip | 59802
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Country | US
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Telephone | 406-327-3057
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Fax | 406-327-3231
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Authorized Official
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Title or Position | ASSISTANT SECRETARY ENROLLMENT
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Name | DONALD WAYNE ANDERSON JR.
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Credential |
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Telephone | 425-358-9786
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | HAN1-0433-7045
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License Number State | MT
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