Basic Information
| Provider Information | |||||||||
| NPI: | 1619385986 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CLIZBE | ||||||||
| FirstName: | BECKY | ||||||||
| MiddleName: | J | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 880 | ||||||||
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| City: | ST. IGNATIUS | ||||||||
| State: | MT | ||||||||
| PostalCode: | 59865 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4067453525 | ||||||||
| FaxNumber: | 4067453529 | ||||||||
| Practice Location | |||||||||
| Address1: | 71972 BITTERROOT JIM RD. | ||||||||
| Address2: | |||||||||
| City: | ARLEE | ||||||||
| State: | MT | ||||||||
| PostalCode: | 59821 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4067453525 | ||||||||
| FaxNumber: | 4067453529 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/30/2014 | ||||||||
| LastUpdateDate: | 07/18/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | NUR-RN-LIC-31509 | MT | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 364SF0001X | NUR-RN-LIC-31509 | MT | Y | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Family Health |
No ID Information.