Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician |
NPI | 1053517466 |
---|---|
Provider Name | Paula Engdahl |
First Address | Missoula, MT 59806-4907 |
Second Address | Missoula, MT 59801-7000 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2007 |
Last Update Date | 08/07/2007 |