Provider Demographics
NPI:1710645403
Name:BIG SKY MEDICAL WELLNESS, PLLC
Entity Type:Organization
Organization Name:BIG SKY MEDICAL WELLNESS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:COLLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:DAWKINS
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:406-885-9057
Mailing Address - Street 1:352 RIDGE LINE DR
Mailing Address - Street 2:
Mailing Address - City:LAKESIDE
Mailing Address - State:MT
Mailing Address - Zip Code:59922-9761
Mailing Address - Country:US
Mailing Address - Phone:406-885-9057
Mailing Address - Fax:844-222-5679
Practice Address - Street 1:352 RIDGE LINE DR
Practice Address - Street 2:
Practice Address - City:LAKESIDE
Practice Address - State:MT
Practice Address - Zip Code:59922-9761
Practice Address - Country:US
Practice Address - Phone:406-885-9057
Practice Address - Fax:844-222-5679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-30
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
1699190611OtherPROVIDER NPI