Organization
DOCTOR AMY HAYNES INC
Active
Other names
Full Circle Natural Medical Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
STEPHANIE RAVEN ND (NATUROPATHIC DOCTOR)
(406) 721-2147
Entity
Organization
Contact information
Practice address
521 S 2ND ST W, MISSOULA, MT 59801-1832
(406) 721-2147
(406) 543-1020
Mailing address
521 S 2ND ST W, MISSOULA, MT 59801-1832
(406) 721-2147
(406) 543-1020
Taxonomy
Speciality
Code
Description
License number
State
175F00000X
Naturopath
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
14923677
CAQH DR. RAVEN
—
01
—
1871061630
INDIVIDUAL NPI DR. STEPHANIE RAVEN
—
01
—
AHC-NAT-LIC-1945
STATE LICENSE DR RAVEN
MT
Enumeration date
12/10/2020
Last updated
12/10/2020
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