Provider Demographics
NPI:1427446228
Name:ARCHIBALD, CARRIE
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:ARCHIBALD
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 1:1600 HOSPITAL WAY
Mailing Address - Street 2:NORTH VALLEY HOSPITAL
Mailing Address - City:WHITEFISH
Mailing Address - State:MT
Mailing Address - Zip Code:59937-7849
Mailing Address - Country:US
Mailing Address - Phone:406-863-3519
Mailing Address - Fax:406-863-3512
Practice Address - Street 1:1600 HOSPITAL WAY
Practice Address - Street 2:NORTH VALLEY HOSPITAL
Practice Address - City:WHITEFISH
Practice Address - State:MT
Practice Address - Zip Code:59937-7849
Practice Address - Country:US
Practice Address - Phone:406-863-3519
Practice Address - Fax:406-863-3512
Is Sole Proprietor?:No
Enumeration Date:2014-12-31
Last Update Date:2014-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT422133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered