Provider Demographics
NPI:1225272057
Name:HOWE, ETHAN MICHAEL CLARK (CRNP)
Entity Type:Individual
Prefix:
First Name:ETHAN
Middle Name:MICHAEL CLARK
Last Name:HOWE
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1117 29TH ST S
Mailing Address - Street 2:SUITE 500
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405-5306
Mailing Address - Country:US
Mailing Address - Phone:406-731-8100
Mailing Address - Fax:406-731-8135
Practice Address - Street 1:1117 29TH ST S
Practice Address - Street 2:SUITE 500
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-5306
Practice Address - Country:US
Practice Address - Phone:406-731-8100
Practice Address - Fax:406-731-8135
Is Sole Proprietor?:No
Enumeration Date:2009-04-23
Last Update Date:2010-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP010207363LA2200X
MT39220363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1023796170001Medicaid
PA2125687OtherBLUE SHIELD HIGH MARK
PA2125687OtherBLUE SHIELD HIGH MARK