Provider Demographics
NPI:1124031786
Name:ORNELAS, ERNESTO E (FNP)
Entity Type:Individual
Prefix:
First Name:ERNESTO
Middle Name:E
Last Name:ORNELAS
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1208 6TH AVE
Mailing Address - Street 2:P.O. BOX 698
Mailing Address - City:SUPERIOR
Mailing Address - State:MT
Mailing Address - Zip Code:59872-9618
Mailing Address - Country:US
Mailing Address - Phone:406-822-4278
Mailing Address - Fax:406-822-4912
Practice Address - Street 1:1208 6TH AVE
Practice Address - Street 2:
Practice Address - City:SUPERIOR
Practice Address - State:MT
Practice Address - Zip Code:59872-9618
Practice Address - Country:US
Practice Address - Phone:406-822-4278
Practice Address - Fax:406-822-4912
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT25639363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0435897Medicaid
MT370570OtherBC/BS OF MONTANA
MTP18536Medicare UPIN
MT81766Medicare Oscar/Certification