Organization Name: | COTTONWOOD CLINIC, LLC |
NPI Number: | 1306262803 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | HEIDE L. APPLEGATE (OWNER) |
Mailing Address: | 310 Main St Deer Lodge |
State: | MT US |
Postal Code: | 597221000 |
Phone Number: | 4068464275 |
Fax Number: | 4068467278 |
NPI Enumeration Date: | 03/10/2014 |
NPI Last Update Date: | 03/10/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 25000 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MT |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |