Provider Demographics
NPI:1760596316
Name:BEAUSOLEIL, MICHELLE C (LPN)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:C
Last Name:BEAUSOLEIL
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:T-9 FORT MISSOULA
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59804-7202
Mailing Address - Country:US
Mailing Address - Phone:406-532-8400
Mailing Address - Fax:
Practice Address - Street 1:307 E PARK AVE
Practice Address - Street 2:SUITE 211
Practice Address - City:ANACONDA
Practice Address - State:MT
Practice Address - Zip Code:59711-2342
Practice Address - Country:US
Practice Address - Phone:406-563-3413
Practice Address - Fax:406-563-7463
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT7459164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse