Provider Demographics
NPI:1225104052
Name:LAPP, LIBBIE SUE (PAC)
Entity Type:Individual
Prefix:
First Name:LIBBIE
Middle Name:SUE
Last Name:LAPP
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 COMMONS LOOP
Mailing Address - Street 2:STE 300
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-1904
Mailing Address - Country:US
Mailing Address - Phone:406-756-7555
Mailing Address - Fax:406-756-7517
Practice Address - Street 1:175 COMMONS LOOP
Practice Address - Street 2:STE 300
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901
Practice Address - Country:US
Practice Address - Phone:406-756-7555
Practice Address - Fax:406-756-7517
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT407363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT04305054Medicaid
Q37407Medicare UPIN
MT04305054Medicaid