Provider Demographics
NPI:1760827315
Name:KIRSCHBAUM, ELLEN M (ARNP)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:M
Last Name:KIRSCHBAUM
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 1:205 KINNIKINNICK LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59912-9009
Mailing Address - Country:US
Mailing Address - Phone:406-892-3221
Mailing Address - Fax:
Practice Address - Street 1:200 COMMONS WAY STE B
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-1915
Practice Address - Country:US
Practice Address - Phone:406-752-5059
Practice Address - Fax:406-751-3079
Is Sole Proprietor?:No
Enumeration Date:2013-05-08
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT127697363LP2300X
MTNUR-APRN-LIC-127697363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care