Individual
EDWARD MICHAEL MONDLOCH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
700 W KENT AVE, MISSOULA, MT 59801-6772
(406) 728-3501
Mailing address
PO BOX 24251, SEATTLE, WA 98124-0251
(503) 372-2740
(503) 372-2754
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
11350
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
433628
—
MT
Enumeration date
07/09/2006
Last updated
12/03/2007
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