1750911962 NPI number — HEATHER LYNN SMITH BSN, MSN

Table of content: HEATHER LYNN SMITH BSN, MSN (NPI 1750911962)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750911962 NPI number — HEATHER LYNN SMITH BSN, MSN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SMITH
Provider First Name:
HEATHER
Provider Middle Name:
LYNN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
BSN, MSN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
VICE
Provider Other First Name:
HEATHER
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1750911962
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/09/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1518 CHOUTEAU ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT BENTON
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59442-9003
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-622-5485
Provider Business Mailing Address Fax Number:
406-622-5670

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1518 CHOUTEAU ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT BENTON
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59442-9003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-622-5485
Provider Business Practice Location Address Fax Number:
406-622-5670
Provider Enumeration Date:
01/16/2020

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: 363L00000X , with the licence number:  146938 , 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)