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General NPI Number Information
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NPI Number | 1497059638
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Entity Type | Organization
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Legal Business Name | JIIVANA INTEGRATIVE HEALTH PLLC
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Dates
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Enumeration Date | 01/03/2011
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Last Update Date | 01/03/2011
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Provider Practice Location Address
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Address Line | 825 W. KENT ST.
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City | MISSOULA
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State | MT
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Zip | 59801-6619
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Country | US
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Telephone | 406-546-3043
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Fax |
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Provider Business Mailing Address
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Address Line | 825 W. KENT ST.
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City | MISSOULA
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State | MT
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Zip | 59801-6619
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Country | US
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Telephone | 406-546-3043
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Fax |
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Authorized Official
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Title or Position | FAMILY NURSE PRACTITIONER
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Name | MS. LAURA MARX
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Credential | APN-C
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Telephone | 406-546-3043
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | APN22313
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License Number State | MT
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