Individual
STACY TAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
535 CLINIC RD E, BOX ELDER, MT 59521-8826
(406) 395-4395
Mailing address
535 CLINIC RD E, BOX ELDER, MT 59521-8826
(406) 395-4395
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
217537
CA
Other
Enumeration date
07/14/2016
Last updated
07/14/2016
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