Provider Demographics
NPI:1518719244
Name:HUDDLESTON, ELIZABETH CAMILLE (FNP-C)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:CAMILLE
Last Name:HUDDLESTON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6010
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59406-6010
Mailing Address - Country:US
Mailing Address - Phone:406-455-3535
Mailing Address - Fax:
Practice Address - Street 1:1518 CHOUTEAU ST
Practice Address - Street 2:
Practice Address - City:FORT BENTON
Practice Address - State:MT
Practice Address - Zip Code:59442-9003
Practice Address - Country:US
Practice Address - Phone:406-622-5485
Practice Address - Fax:406-466-5670
Is Sole Proprietor?:No
Enumeration Date:2024-04-04
Last Update Date:2024-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTNUR-APRN-LIC-235303363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily