Provider Demographics
NPI:1063163160
Name:LAFONTAINE, BRANDY LEE
Entity type:Individual
Prefix:
First Name:BRANDY
Middle Name:LEE
Last Name:LAFONTAINE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 H ST
Mailing Address - Street 2:
Mailing Address - City:POPLAR
Mailing Address - State:MT
Mailing Address - Zip Code:59255-7817
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:550 6TH AVE N
Practice Address - Street 2:
Practice Address - City:WOLF POINT
Practice Address - State:MT
Practice Address - Zip Code:59201-6000
Practice Address - Country:US
Practice Address - Phone:406-653-5628
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-11
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QM0706XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMedical Technologist