Provider Demographics
NPI:1609861582
Name:ANTONSON, BARBARA ANNE (ARNP)
Entity Type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:ANNE
Last Name:ANTONSON
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 KNAPP ST
Mailing Address - Street 2:
Mailing Address - City:WOLF POINT
Mailing Address - State:MT
Mailing Address - Zip Code:59201-1826
Mailing Address - Country:US
Mailing Address - Phone:406-653-2150
Mailing Address - Fax:406-653-6591
Practice Address - Street 1:301 KNAPP ST
Practice Address - Street 2:
Practice Address - City:WOLF POINT
Practice Address - State:MT
Practice Address - Zip Code:59201-1826
Practice Address - Country:US
Practice Address - Phone:406-653-2150
Practice Address - Fax:406-653-6591
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTRN7260363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9603952Medicaid
WA9603952Medicaid
WAAB06530Medicare ID - Type Unspecified