Provider Demographics
NPI:1699136416
Name:KAMPEN, MYRNA
Entity type:Individual
Prefix:
First Name:MYRNA
Middle Name:
Last Name:KAMPEN
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 1:1250 ROCK SPGS
Mailing Address - Street 2:
Mailing Address - City:RESERVE
Mailing Address - State:MT
Mailing Address - Zip Code:59258-9702
Mailing Address - Country:US
Mailing Address - Phone:406-286-5684
Mailing Address - Fax:
Practice Address - Street 1:2900 4TH AVE N
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-1266
Practice Address - Country:US
Practice Address - Phone:406-768-2172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-08
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT396246QM0706X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246QM0706XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, PathologyMedical Technologist