Provider Demographics
NPI:1174564298
Name:SMITH, MICHELLE J (NP)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:J
Last Name:SMITH
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 OSLOSKI RD
Mailing Address - Street 2:
Mailing Address - City:EUREKA
Mailing Address - State:MT
Mailing Address - Zip Code:59917-9217
Mailing Address - Country:US
Mailing Address - Phone:406-297-3145
Mailing Address - Fax:406-297-3364
Practice Address - Street 1:304 OSLOSKI RD
Practice Address - Street 2:
Practice Address - City:EUREKA
Practice Address - State:MT
Practice Address - Zip Code:59917-9217
Practice Address - Country:US
Practice Address - Phone:406-297-3145
Practice Address - Fax:406-297-3364
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2025-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTRN19338363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT373210OtherBLUE CROSS
MT433755Medicaid
MT433755Medicaid
S77078Medicare UPIN