Doctor Name: | MRS. CHARLENE PONTORIERO |
NPI Number: | 1457424244 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | NP |
License Number: | R30872 |
Business Practice Address: | 107 Dilworth St Glendive, MT - 593302053 |
Business Phone Number: | 4063458935 |
Business Fax Number: | 4063458908 |
Mailing Address: | 107 Dilworth St, GLENDIVE |
State: | MT |
Postal Code: | 593302053 |
Phone Number: | 4063458935 |
Fax Number: | 4063458908 |
NPI Enumeration Date: | 11/17/2006 |
NPI Last Update Date: | 02/02/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | R30872 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | ND |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |