Provider Demographics
NPI:1548740822
Name:AVA HEALTH LLC
Entity Type:Organization
Organization Name:AVA HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/FNP
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:WEAVER KNOWLES
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:406-544-0628
Mailing Address - Street 1:2875 TINA AVE STE 107
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59808-1582
Mailing Address - Country:US
Mailing Address - Phone:406-544-0628
Mailing Address - Fax:406-302-0899
Practice Address - Street 1:2875 TINA AVE STE 107
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59808-1582
Practice Address - Country:US
Practice Address - Phone:406-544-0628
Practice Address - Fax:406-302-0899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-16
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT131528363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1205313590OtherINDIVIDUAL NPI NUMBER