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General NPI Number Information
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NPI Number | 1861511669
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Entity Type | Organization
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Legal Business Name | ANACONDA DEER LODGE CO FAMILY PLANNING
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Dates
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Enumeration Date | 03/29/2007
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Last Update Date | 09/25/2024
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Provider Practice Location Address
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Address Line | 118 E 7TH ST STE 1E
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City | ANACONDA
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State | MT
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Zip | 59711-2953
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Country | US
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Telephone | 406-563-7863
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Fax | 406-563-2387
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Provider Business Mailing Address
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Address Line | 118 E 7TH ST STE 1E
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City | ANACONDA
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State | MT
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Zip | 59711-2953
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Country | US
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Telephone | 406-563-7863
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Fax | 406-563-2387
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Authorized Official
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Title or Position | DIRECTOR
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Name | LAUREN BOLTON
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Credential |
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Telephone | 406-563-7863
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LW0102X
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Taxonomy Name | Women's Health Nurse Practitioner
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License Number | RN11730
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License Number State | MT
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Taxonomy #2
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Taxonomy Code | 261QA0005X
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Taxonomy Name | Ambulatory Family Planning Facility
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License Number |
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License Number State |
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