Provider Information for 1306364153
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Ms. TONYA M CARPENTER
Sex: Female
NPI: 1306364153
Last Updated: 2020-06-04
Certification Date: 2020-06-04
Certification Date: 2020-06-04
Details
| Name | Value | ||||||||||||||||
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| NPI | 1306364153 | ||||||||||||||||
| Enumeration Date | 2017-08-31 | ||||||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||||||
| Sole Proprietor | YES | ||||||||||||||||
| Status | Active | ||||||||||||||||
| Mailing Address | 264 CONRAD DUPUYER RD CONRAD, MT 59425-9326 United States Phone: 406-949-1167 | Fax:406-278-0330 | ||||||||||||||||
| Primary Practice Address | 600 S MAIN ST STE 10 CONRAD, MT 59425-2532 United States Phone: 406-278-0440 | Fax:406-278-0330 | ||||||||||||||||
| Secondary Practice Address(es) | 100 MAIN ST STE 3A | ||||||||||||||||
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