Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | MT8723 | MT |
NPI | 1053321273 |
---|---|
Provider Name | Michele A Danicich |
First Address | Liberty Lake, WA 99019-0012 |
Second Address | Missoula, MT 59802-2951 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2006 |
Last Update Date | 11/05/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G50831 | (02) |