Provider Demographics
NPI:1174618755
Name:KLEPPEN, ELIZABETH ELLEN (RN, PA-C)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ELLEN
Last Name:KLEPPEN
Suffix:
Gender:F
Credentials:RN, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 266
Mailing Address - Street 2:
Mailing Address - City:OUTLOOK
Mailing Address - State:MT
Mailing Address - Zip Code:59252-0266
Mailing Address - Country:US
Mailing Address - Phone:406-895-2520
Mailing Address - Fax:
Practice Address - Street 1:818 2ND AVENUE EAST
Practice Address - Street 2:
Practice Address - City:CULBERTSON
Practice Address - State:MT
Practice Address - Zip Code:59218-0110
Practice Address - Country:US
Practice Address - Phone:406-787-6400
Practice Address - Fax:406-787-6473
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT120363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0438555Medicaid
MT95551004OtherRAILROAD MEDICARE
MT95551004OtherRAILROAD MEDICARE