Basic Information
| Provider Information | |||||||||
| NPI: | 1922519131 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MARSH | ||||||||
| FirstName: | KATE | ||||||||
| MiddleName: | ADELE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 105 ARROWHEAD DR | ||||||||
| Address2: | |||||||||
| City: | MILES CITY | ||||||||
| State: | MT | ||||||||
| PostalCode: | 593015804 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 210 S WINCHESTER AVE | ||||||||
| Address2: | |||||||||
| City: | MILES CITY | ||||||||
| State: | MT | ||||||||
| PostalCode: | 593014757 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4068748700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/14/2017 | ||||||||
| LastUpdateDate: | 04/04/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | 128564 | MT | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 363LP2300X | NUR-APRN-LIC-128564 | MT | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Primary Care |
No ID Information.