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General NPI Number Information
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NPI Number | 1841080694
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Entity Type | Individual
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Provider Name | AMANDA LODGE RN
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Gender | Female
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Dates
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Enumeration Date | 05/06/2025
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Last Update Date | 05/06/2025
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Provider Practice Location Address
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Address Line | 579 BELT CREEK RD
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City | BELT
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State | MT
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Zip | 59412-8007
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Country | US
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Telephone | 406-899-1630
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Fax |
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Provider Business Mailing Address
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Address Line | 579 BELT CREEK RD
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City | BELT
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State | MT
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Zip | 59412-8007
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Country | US
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Telephone | 406-899-1630
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163WM0705X
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Taxonomy Name | Medical-Surgical Registered Nurse
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License Number | 719901
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 163WM0705X
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Taxonomy Name | Medical-Surgical Registered Nurse
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License Number | NUR-RN-LIC-146531
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License Number State | MT
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