1326351339 NPI number — HEATHER RENEE BLACK R.N.

Table of content: HEATHER RENEE BLACK R.N. (NPI 1326351339)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326351339 NPI number — HEATHER RENEE BLACK R.N.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BLACK
Provider First Name:
HEATHER
Provider Middle Name:
RENEE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
R.N.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DIXON
Provider Other First Name:
HEATHER
Provider Other Middle Name:
RENEE
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:
1326351339
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/05/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
232 2ND AVE SE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CUT BANK
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59427-3416
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-845-4993
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
760 HOSPITAL CIRCLE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BROWNING
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59417
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-338-6100
Provider Business Practice Location Address Fax Number:
406-338-6195
Provider Enumeration Date:
07/19/2010

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: 163WC0400X , with the licence number:  126733 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163WG0000X , with the licence number: 126733 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163WM0705X , with the licence number: 126733 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163WP2201X , with the licence number: 126733 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163WP2201X , with the licence number: 31609 , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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