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General NPI Number Information
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NPI Number | 1932596293
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Entity Type | Individual
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Provider Name | SUSANNAH MCVAY-RIES APRN-NNP-BC
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Gender | Female
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Dates
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Enumeration Date | 04/23/2015
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Last Update Date | 04/23/2015
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Provider Practice Location Address
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Address Line | 2827 FORT MISSOULA RD
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City | MISSOULA
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State | MT
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Zip | 59804-7408
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Country | US
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Telephone | 406-327-4058
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Fax | 406-327-4535
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Provider Business Mailing Address
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Address Line | 2827 FORT MISSOULA RD
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City | MISSOULA
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State | MT
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Zip | 59804-7408
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Country | US
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Telephone | 406-327-4058
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Fax | 406-327-4535
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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 | 363LN0000X
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Taxonomy Name | Neonatal Nurse Practitioner
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License Number | NUR-RN-LIC-37121
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License Number State | MT
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