1710059621 NPI number — MS. NANCY LEIGH DALTON-JOHNSON RPH

Table of content: MS. NANCY LEIGH DALTON-JOHNSON RPH (NPI 1710059621)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710059621 NPI number — MS. NANCY LEIGH DALTON-JOHNSON RPH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DALTON-JOHNSON
Provider First Name:
NANCY
Provider Middle Name:
LEIGH
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
RPH
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:
1710059621
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 305
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ARLEE
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59821-0305
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-726-4134
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
110 N. MAIN ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ST IGNATIUS
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59865
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-745-3000
Provider Business Practice Location Address Fax Number:
406-745-3003
Provider Enumeration Date:
11/15/2006

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: 183500000X , with the licence number:  3885 , 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: 3885 . This is a "LICENSE" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".




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