Provider Demographics
NPI:1740421023
Name:SUND, JANA J (CNM)
Entity Type:Individual
Prefix:MRS
First Name:JANA
Middle Name:J
Last Name:SUND
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 SUNNYVIEW LN
Mailing Address - Street 2:SUITE 101
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-3135
Mailing Address - Country:US
Mailing Address - Phone:406-751-8009
Mailing Address - Fax:406-257-6463
Practice Address - Street 1:210 SUNNYVIEW LN
Practice Address - Street 2:SUITE 101
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-3135
Practice Address - Country:US
Practice Address - Phone:406-751-8009
Practice Address - Fax:406-257-6463
Is Sole Proprietor?:No
Enumeration Date:2009-03-16
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT28416367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
12970OtherACNM/AMCB
MT1740421023OtherBCBS
MT1740421023Medicaid
011004252Medicare PIN