=====================================================
General NPI Number Information
=====================================================
NPI Number | 1720640204
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AMBER JEWEL DEAN DNP, PMHNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/03/2019
-----------------------------------------------------
Last Update Date | 07/03/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2004 HOSPITAL WAY
-----------------------------------------------------
City | WHITEFISH
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59937-7858
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-862-1030
-----------------------------------------------------
Fax | 406-862-1556
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 140 DENVER AVE
-----------------------------------------------------
City | KALISPELL
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59901-9003
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 308-672-1907
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | NUR-APRN-LIC-145700
-----------------------------------------------------
License Number State | MT
-----------------------------------------------------