Provider Demographics
NPI:1508029505
Name:FAHLQUIST, JEANNIE MARLENE (NP-C)
Entity Type:Individual
Prefix:
First Name:JEANNIE
Middle Name:MARLENE
Last Name:FAHLQUIST
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39 NEILL AVE
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-3330
Mailing Address - Country:US
Mailing Address - Phone:406-443-5354
Mailing Address - Fax:406-443-5727
Practice Address - Street 1:39 NEILL AVE
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-3330
Practice Address - Country:US
Practice Address - Phone:406-443-5354
Practice Address - Fax:406-443-5727
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTNUR-APRN-LIC-100460363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily