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General NPI Number Information
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NPI Number | 1548740822
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Entity Type | Organization
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Legal Business Name | AVA HEALTH LLC
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Dates
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Enumeration Date | 08/16/2018
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Last Update Date | 09/15/2022
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Provider Practice Location Address
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Address Line | 2875 TINA AVE STE 107
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City | MISSOULA
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State | MT
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Zip | 59808-1582
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Country | US
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Telephone | 406-544-0628
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Fax | 406-302-0899
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Provider Business Mailing Address
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Address Line | 2875 TINA AVE STE 107
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City | MISSOULA
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State | MT
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Zip | 59808-1582
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Country | US
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Telephone | 406-544-0628
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Fax | 406-302-0899
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Authorized Official
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Title or Position | OWNER/FNP
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Name | MICHELLE WEAVER KNOWLES
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Credential | FNP
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Telephone | 406-544-0628
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 131528
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License Number State | MT
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