MEDICARE: ARLON HARRIS BENNETT APRN, FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	F0814197	MT
2	363L00000X	Nurse Practitioner	100595	MT

General Provider Information

NPI Number	:	1083015242
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ARLON HARRIS BENNETT APRN, FNP-C

Provider Business Mailing Address
First Line	:	2230 27TH AVE STE 3
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59804-5128
Country	:	US
Telephone Number	:	406-721-4540
Fax Number	:	406-721-1838

Provider Business Practice Location Address
First Line	:	2230 27TH AVE STE 3
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59804-5128
Country	:	US
Telephone Number	:	406-721-4540
Fax Number	:	406-721-1838

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/08/2014
Last Update Date	:	07/11/2019

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