Individual
TERESA HESTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
96 CLINIC RD N, BOX ELDER, MT 59521-8849
(406) 395-1617
Mailing address
PO BOX 346, BIG SANDY, MT 59520-0346
(406) 945-0393
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN1249921
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0807119654120
DL
MT
Enumeration date
12/27/2017
Last updated
12/27/2017
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