Provider Demographics
NPI:1073516167
Name:DUPREE, LINDA LORRAINE (PAC)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:LORRAINE
Last Name:DUPREE
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:LINDA
Other - Middle Name:LORRAINE
Other - Last Name:LIESE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 35100
Mailing Address - Street 2:801 NORTH 29TH ST
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59107-5100
Mailing Address - Country:US
Mailing Address - Phone:406-357-2294
Mailing Address - Fax:406-357-3252
Practice Address - Street 1:801 N 29TH ST
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-0905
Practice Address - Country:US
Practice Address - Phone:406-945-4023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2016-06-11
Deactivation Date:2007-07-17
Deactivation Code:
Reactivation Date:2007-08-20
Provider Licenses
StateLicense IDTaxonomies
MT303363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT720188Medicaid
MTP70633Medicare UPIN
MT720188Medicaid