Individual
MRS. SEVERINE MIA CLEMENCE BASHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
211 E 2ND ST, LIBBY, MT 59923-2047
(406) 293-8711
(406) 293-8735
Mailing address
116 CONIFER RD, LIBBY, MT 59923-2958
(406) 293-8711
(406) 293-8735
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
34352
MT
Other
Enumeration date
01/24/2008
Last updated
12/11/2014
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