Individual
CHARLA M FONTAINE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2835 FORT MISSOULA RD BLDG 3, MISSOULA, MT 59804-7423
(406) 721-5600
Mailing address
PO BOX 7609, MISSOULA, MT 59807-7609
(401) 721-5600
(406) 721-3907
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
595
MT
Other
Enumeration date
11/01/2006
Last updated
06/21/2021
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