Individual
BODEE ALT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
APRN
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
(406) 543-7271
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
44583
MT
Other
Enumeration date
09/24/2015
Last updated
10/01/2015
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