Provider Demographics
NPI:1306143177
Name:EMERSON, STEPHEN MICHAEL (RN)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:MICHAEL
Last Name:EMERSON
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:MIKE
Other - Middle Name:
Other - Last Name:EMERSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:100 CHEYENNE AVE
Mailing Address - Street 2:
Mailing Address - City:LAME DEER
Mailing Address - State:MT
Mailing Address - Zip Code:59043
Mailing Address - Country:US
Mailing Address - Phone:406-477-4400
Mailing Address - Fax:406-477-4427
Practice Address - Street 1:100 CHEYENNE AVE
Practice Address - Street 2:
Practice Address - City:LAME DEER
Practice Address - State:MT
Practice Address - Zip Code:59043
Practice Address - Country:US
Practice Address - Phone:406-477-4400
Practice Address - Fax:406-477-4427
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-14
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR74327163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency