Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC1500X | Nurse Practitioner - Community Health | 70410 | MT |
NPI | 1659324226 |
---|---|
Provider Name | Anine Mccallum |
First Address | Miles City, MT 59301-4757 |
Second Address | Miles City, MT 59301-5094 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2006 |
Last Update Date | 31/07/2017 |