Individual
KODI DANIELLE TALL BULL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2230 N RESERVE ST STE 402, MISSOULA, MT 59808-1364
(406) 721-0533
(406) 728-4463
Mailing address
2827 FORT MISSOULA RD, MISSOULA, MT 59804-7408
(406) 327-3805
(406) 327-4480
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
NUR-APRN-LIC-129860
MT
Other
Enumeration date
04/02/2018
Last updated
04/02/2018
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