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General NPI Number Information
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NPI Number | 1376606517
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Entity Type | Organization
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Legal Business Name | POWDER RIVER PUBLICHEALTH
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Dates
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Enumeration Date | 12/19/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 507 N. LINCOLN
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City | BROADUS
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State | MT
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Zip | 59317-0210
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Country | US
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Telephone | 406-436-2297
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Fax | 406-436-2315
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Provider Business Mailing Address
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Address Line | PO BOX 210 507 N. LINCOLN
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City | BROADUS
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State | MT
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Zip | 59317-0210
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Country | US
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Telephone | 406-436-2297
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Fax | 406-436-2315
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Authorized Official
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Title or Position | RN DIRECTOR
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Name | MRS. JACI PHILLIPS
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Credential | RN
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Telephone | 406-436-2297
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WC1500X
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Taxonomy Name | Community Health Registered Nurse
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License Number | RN24922
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License Number State | MT
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