Individual
MAE O BERENTSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
160 HERITAGE WAY STE 202, KALISPELL, MT 59901-3127
(406) 752-8433
(406) 756-6768
Mailing address
160 HERITAGE WAY STE 202, KALISPELL, MT 59901-3127
(406) 752-8433
(406) 756-6768
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
100419
MT
363L00000X
Nurse Practitioner
RN26212
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1972558120
BCBS
MT
05
—
1972558120
—
MT
Enumeration date
05/24/2006
Last updated
11/27/2023
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