1710328059 NPI number — STEPHANIE LYNNE SANTALA-MOORE WHNP

Table of content: STEPHANIE LYNNE SANTALA-MOORE WHNP (NPI 1710328059)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710328059 NPI number — STEPHANIE LYNNE SANTALA-MOORE WHNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SANTALA-MOORE
Provider First Name:
STEPHANIE
Provider Middle Name:
LYNNE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
WHNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1710328059
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/15/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
285 CAPE COD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BILLINGS
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59102-6906
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-633-1998
Provider Business Mailing Address Fax Number:
406-247-5187

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
701 S 27TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BILLINGS
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59101-4511
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-247-5100
Provider Business Practice Location Address Fax Number:
406-247-5161
Provider Enumeration Date:
07/15/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LW0102X , with the licence number:  APRN25808 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 25808 . This is a "MONTANA STATE BOARD OF NURSING" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".