Provider Demographics
NPI:1518509298
Name:RICKHOFF, STEFANIE (PA)
Entity Type:Individual
Prefix:
First Name:STEFANIE
Middle Name:
Last Name:RICKHOFF
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 N MILES AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:HARDIN
Mailing Address - State:MT
Mailing Address - Zip Code:59034-2356
Mailing Address - Country:US
Mailing Address - Phone:406-665-2800
Mailing Address - Fax:406-665-1159
Practice Address - Street 1:16 N MILES AVE STE 101
Practice Address - Street 2:
Practice Address - City:HARDIN
Practice Address - State:MT
Practice Address - Zip Code:59034-2356
Practice Address - Country:US
Practice Address - Phone:406-665-2800
Practice Address - Fax:406-665-1159
Is Sole Proprietor?:No
Enumeration Date:2019-10-14
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTPENDING363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant