Provider Demographics
NPI:1992051064
Name:MOTSCHENBACHER, RUSSELL CHARLES (APRN)
Entity type:Individual
Prefix:
First Name:RUSSELL
Middle Name:CHARLES
Last Name:MOTSCHENBACHER
Suffix:
Gender:M
Credentials:APRN
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 2151
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59403-2151
Mailing Address - Country:US
Mailing Address - Phone:406-788-6123
Mailing Address - Fax:
Practice Address - Street 1:1601 2ND AVE N
Practice Address - Street 2:SUITE 650
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59401-3259
Practice Address - Country:US
Practice Address - Phone:406-788-6123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-26
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT22956363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTM011002617Medicare PIN
MTM011002764Medicare PIN