Provider Demographics
NPI:1346807344
Name:FRENCHTOWN FAMILY MEDICAL & WELLNESS, PC
Entity Type:Organization
Organization Name:FRENCHTOWN FAMILY MEDICAL & WELLNESS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STACEY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:RIFFE-DENTON
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, FNP-BC
Authorized Official - Phone:406-360-3352
Mailing Address - Street 1:5429 FILLY LN
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59808-5465
Mailing Address - Country:US
Mailing Address - Phone:406-360-3352
Mailing Address - Fax:
Practice Address - Street 1:16862 BECKWITH ST STE S
Practice Address - Street 2:
Practice Address - City:FRENCHTOWN
Practice Address - State:MT
Practice Address - Zip Code:59834-9001
Practice Address - Country:US
Practice Address - Phone:406-360-3352
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-05-24
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty