Provider Demographics
NPI:1326351339
Name:BLACK, HEATHER RENEE (RN)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:RENEE
Last Name:BLACK
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:RENEE
Other - Last Name:DIXON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:232 2ND AVE SE
Mailing Address - Street 2:
Mailing Address - City:CUT BANK
Mailing Address - State:MT
Mailing Address - Zip Code:59427-3416
Mailing Address - Country:US
Mailing Address - Phone:406-845-4993
Mailing Address - Fax:
Practice Address - Street 1:760 HOSPITAL CIRCLE
Practice Address - Street 2:
Practice Address - City:BROWNING
Practice Address - State:MT
Practice Address - Zip Code:59417
Practice Address - Country:US
Practice Address - Phone:406-338-6100
Practice Address - Fax:406-338-6195
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-19
Last Update Date:2021-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT126733163WC0400X, 163WG0000X, 163WM0705X, 163WP2201X
AK31609163WP2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163WP2201XNursing Service ProvidersRegistered NurseAmbulatory Care
No163WC0400XNursing Service ProvidersRegistered NurseCase ManagementGroup - Single Specialty
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical