# DR. JENNIE WALKER ECKSTROM

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1003867037
- **Gender:** F
- **Credential:** M.D.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 10784 | MT | Yes |
| 207Q00000X | Family Medicine Physician | M9143 | ID | — |

## Other

- **Enumeration date:** 05/15/2006
- **Last updated:** 05/12/2008

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 000008287 | MEDICARE PART B GRP ID\# | MT |
| 01 | — | 000094766 | BLUE CROSS/SHIELD PIN | MT |
| 05 | — | 0143442 | — | MT |
| 01 | — | 10784 | MONTANA STATE LICENSE | MT |
| 01 | — | 1104882232 | GLACIER MEDICAL ASSOC NPI | MT |
| 01 | — | 27D0411341 | CLIA ID\#--LAB CERT | MT |
| 01 | — | 810350909 | FEIN | MT |
| 01 | — | CI2709 | RAILROAD MEDICARE GRP ID\# | MT |
| 01 | — | P00234037 | RAILROAD MEDICARE PIN\# | MT |