Provider Demographics
NPI:1710103569
Name:KINDRED, DALE STUBBS (RN BSN)
Entity Type:Individual
Prefix:
First Name:DALE
Middle Name:STUBBS
Last Name:KINDRED
Suffix:
Gender:F
Credentials:RN BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3405 HELENA DR
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59803-2715
Mailing Address - Country:US
Mailing Address - Phone:406-251-5611
Mailing Address - Fax:
Practice Address - Street 1:634 EDDY AVE
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59812-1851
Practice Address - Country:US
Practice Address - Phone:406-243-4330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT16596163WC1400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1400XNursing Service ProvidersRegistered NurseCollege Health