Provider Demographics
NPI:1699872986
Name:DAVIES, DENISE LYNN
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:LYNN
Last Name:DAVIES
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:PO BOX 186
Mailing Address - Street 2:
Mailing Address - City:SOMERS
Mailing Address - State:MT
Mailing Address - Zip Code:59932-0186
Mailing Address - Country:US
Mailing Address - Phone:406-857-2629
Mailing Address - Fax:
Practice Address - Street 1:113 PAVILLION HILL RD
Practice Address - Street 2:
Practice Address - City:SOMERS
Practice Address - State:MT
Practice Address - Zip Code:59932-0186
Practice Address - Country:US
Practice Address - Phone:406-261-3426
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT850174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist