Individual
MS. MYRNA JEANIE MENTIKOV
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
123 S 27TH ST, BILLINGS, MT 59101-4200
(406) 247-3350
Mailing address
123 S 27TH ST, BILLINGS, MT 59101-4227
(406) 247-3350
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
362
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4302571
—
MT
Enumeration date
09/23/2005
Last updated
06/25/2013
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