Doctor Name: | MRS. MEREDITH CAROZZA DUVALL KRUTAR |
NPI Number: | 1295808228 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | FNP-BC |
License Number: | NUR-RN-LIC-26948 |
Business Practice Address: | 3 Shadow Ridge Rd Clancy, MT - 596349683 |
Business Phone Number: | 4063603870 |
Business Fax Number: | |
Mailing Address: | 3 Shadow Ridge Rd, CLANCY |
State: | MT |
Postal Code: | 596349683 |
Phone Number: | 4063603870 |
Fax Number: | |
NPI Enumeration Date: | 11/16/2006 |
NPI Last Update Date: | 08/04/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | NUR-RN-LIC-26948 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MT |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |