Basic Information
| Provider Information | |||||||||
| NPI: | 1003067182 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ST. PATRICK HOSPITAL AND HEALTH SCIENCES CENTER | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | WOMEN'S CARE CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 500 W BROADWAY LEVEL 3 | ||||||||
| Address2: | |||||||||
| City: | MISSOULA | ||||||||
| State: | MT | ||||||||
| PostalCode: | 59802 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4063273057 | ||||||||
| FaxNumber: | 4063273231 | ||||||||
| Practice Location | |||||||||
| Address1: | 500 W BROADWAY ST # LEVEL3 | ||||||||
| Address2: | |||||||||
| City: | MISSOULA | ||||||||
| State: | MT | ||||||||
| PostalCode: | 598024008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4063273057 | ||||||||
| FaxNumber: | 4063273231 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/07/2008 | ||||||||
| LastUpdateDate: | 10/07/2008 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | SCHENK | ||||||||
| AuthorizedOfficialFirstName: | ELIZABETH | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | FACILITATOR | ||||||||
| AuthorizedOfficialTelephone: | 4063292730 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | RN | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LW0102X | HAN1-0433-7045 | MT | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health |
No ID Information.