Provider Demographics
NPI:1558706796
Name:PEILA, ALTA (RD)
Entity Type:Individual
Prefix:
First Name:ALTA
Middle Name:
Last Name:PEILA
Suffix:
Gender:F
Credentials:RD
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 551
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MT
Mailing Address - Zip Code:59019-0551
Mailing Address - Country:US
Mailing Address - Phone:406-322-1095
Mailing Address - Fax:406-322-5207
Practice Address - Street 1:710 N 11TH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:MT
Practice Address - Zip Code:59019-0959
Practice Address - Country:US
Practice Address - Phone:406-322-1000
Practice Address - Fax:406-322-5207
Is Sole Proprietor?:No
Enumeration Date:2013-05-01
Last Update Date:2013-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT20255133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT271330Medicare Oscar/Certification