Individual
ALEXIS VANTIEM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1208 6TH AVE. E, SUPERIOR, MT 59872
(406) 822-4803
(406) 822-3848
Mailing address
P.O. BOX 66, SUPERIOR, MT 59872
(406) 822-4803
(406) 822-3848
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
MED-PAC-LIC-145618
MT
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
07/06/2023
Last updated
12/01/2025
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