Individual
MARK E VANDOLAH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
7 VANDOLAH ROAD, THREE FORKS, MT 59752-1330
(406) 285-6588
(406) 285-9012
Mailing address
PO BOX 1330, 7 VANDOLAH ROAD, THREE FORKS, MT 59752-1330
(406) 285-6588
(406) 285-9012
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN14372
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4308525
—
MT
Enumeration date
02/16/2006
Last updated
03/11/2008
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