Organization
PROVIDENCE HEALTH & SERVICES MT
Active
Other names
Providence Health Express
Organization subpart
No
Provider details
NPI number
Authorized official
DONALD W ANDERSON JR. (ASSISTANT SECRETARY ENROLLMENTS)
(425) 358-9786
Entity
Organization
Contact information
Practice address
500 W BROADWAY ST, MISSOULA, MT 59802-4008
(406) 543-7271
Mailing address
PO BOX 12, LIBERTY LAKE, WA 99019-0012
(866) 747-2455
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
—
—
Other
Enumeration date
10/18/2016
Last updated
05/05/2025
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