Individual
SOPHIA RAELYN VIVANT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
700 W KENT AVE, MISSOULA, MT 59801-6772
(406) 541-3277
(406) 541-3811
Mailing address
700 W KENT AVE, MISSOULA, MT 59801-6772
(406) 541-3277
(406) 541-3811
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
129044
MT
Other
Enumeration date
09/01/2021
Last updated
09/18/2024
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