Provider Demographics
NPI:1467522615
Name:BLOCK, LOTTIE LUCILLE (FNP)
Entity Type:Individual
Prefix:
First Name:LOTTIE
Middle Name:LUCILLE
Last Name:BLOCK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:LOTTIE
Other - Middle Name:LUCILLE
Other - Last Name:SAMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1075 N MERIDIAN RD
Mailing Address - Street 2:388 YODELIN RIDGE ROAD
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-3567
Mailing Address - Country:US
Mailing Address - Phone:406-752-5673
Mailing Address - Fax:406-752-5672
Practice Address - Street 1:1075 NORTH MERIDIAN
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59904-3699
Practice Address - Country:US
Practice Address - Phone:406-752-5673
Practice Address - Fax:406-752-5672
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTRN33154363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTMB1524025OtherDEA