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Organization
DOCTOR AMY HAYNES INC
Active
Organization
DOCTOR AMY HAYNES INC
Active
Other names
Full Circle Natural Medical Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHANIE RAVEN ND (NATUROPATHIC DOCTOR)
(406) 721-2147
Entity
Organization
Contact information
Practice address
521 S 2ND ST W, MISSOULA, MT 59801-1832
(406) 721-2147
(406) 543-1020
Mailing address
521 S 2ND ST W, MISSOULA, MT 59801-1832
(406) 721-2147
(406) 543-1020
Taxonomy
Speciality
Code
Description
License number
State
175F00000X
Naturopath
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14923677
CAQH DR. RAVEN
—
01
—
1871061630
INDIVIDUAL NPI DR. STEPHANIE RAVEN
—
01
—
AHC-NAT-LIC-1945
STATE LICENSE DR RAVEN
MT
Enumeration date
12/10/2020
Last updated
12/10/2020
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