| Organization Name: | CENTRAL MEDISPA LLC |
| NPI Number: | 1144683475 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | KELLY ALVSTAD (ADMINISTRATOR) |
| Mailing Address: | 309 S Central Ave Sidney |
| State: | MT US |
| Postal Code: | 592704127 |
| Phone Number: | 4064885000 |
| Fax Number: | 8447661639 |
| NPI Enumeration Date: | 04/04/2016 |
| NPI Last Update Date: | 04/04/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | NUR APRN LIC 100657 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MT |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |