Provider Demographics
NPI:1043599939
Name:EICKHOLT, RHONDA (MHAPRN PC)
Entity Type:Individual
Prefix:DR
First Name:RHONDA
Middle Name:
Last Name:EICKHOLT
Suffix:
Gender:F
Credentials:MHAPRN PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3972 HIGHWAY 93 NORTH (N.)
Mailing Address - Street 2:SUITE C
Mailing Address - City:STEVENSVILLE
Mailing Address - State:MT
Mailing Address - Zip Code:59870-6494
Mailing Address - Country:US
Mailing Address - Phone:406-777-6958
Mailing Address - Fax:406-777-5869
Practice Address - Street 1:504 MAIN ST
Practice Address - Street 2:
Practice Address - City:STEVENSVILLE
Practice Address - State:MT
Practice Address - Zip Code:59870-2836
Practice Address - Country:US
Practice Address - Phone:406-777-6958
Practice Address - Fax:406-777-5869
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-09
Last Update Date:2019-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT37331363LP0808X
MTMT37331363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
M011002018Medicare UPIN