Provider Demographics
NPI:1316477052
Name:URICK, LISA RENEE
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:RENEE
Last Name:URICK
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 1:13 VALLEY DRIVE
Mailing Address - Street 2:
Mailing Address - City:BELT
Mailing Address - State:MT
Mailing Address - Zip Code:59412-0075
Mailing Address - Country:US
Mailing Address - Phone:406-277-3390
Mailing Address - Fax:
Practice Address - Street 1:13 VALLEY DRIVE
Practice Address - Street 2:
Practice Address - City:BELT
Practice Address - State:MT
Practice Address - Zip Code:59412-0075
Practice Address - Country:US
Practice Address - Phone:406-277-3390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor