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General NPI Number Information
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NPI Number | 1891801817
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Entity Type | Organization
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Legal Business Name | ELLEN S DEWOLFE MSN P.C.
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Dates
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Enumeration Date | 08/22/2006
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Last Update Date | 10/10/2019
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Provider Practice Location Address
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Address Line | 125 BANK ST STE 310
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City | MISSOULA
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State | MT
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Zip | 59802-4413
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Country | US
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Telephone | 406-549-7325
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Fax | 406-549-7559
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Provider Business Mailing Address
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Address Line | PO BOX 3138
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City | MISSOULA
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State | MT
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Zip | 59806-3138
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Country | US
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Telephone | 406-549-7325
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Fax | 406-549-7559
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Authorized Official
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Title or Position | OWNER
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Name | ELLEN S DEWOLFE
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Credential | MSN CNS
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Telephone | 65-497-3254
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 364SP0808X
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Taxonomy Name | Psychiatric/Mental Health Clinical Nurse Specialist
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License Number | RN16128
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License Number State | MT
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