Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363LA2100X | Nurse Practitioner - Acute Care | 0024174096 | VA |
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 0024174096 | VA |
N | 363LC0200X | Nurse Practitioner - Critical Care Medicine | NUR-APRN-LIC-184834 | MT |
NPI | 1306379607 |
---|---|
Provider Name | Stephene Aizcorbe Hertwig |
First Address | Kalispell, MT 59901-2936 |
Second Address | Kalispell, MT 59901-3167 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2017 |
Last Update Date | 29/11/2021 |