Provider Demographics
NPI:1790076172
Name:SCHILDT, HEATHER LANAINA (RN)
Entity Type:Individual
Prefix:MISS
First Name:HEATHER
Middle Name:LANAINA
Last Name:SCHILDT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 356
Mailing Address - Street 2:
Mailing Address - City:BROWNING
Mailing Address - State:MT
Mailing Address - Zip Code:59417-0356
Mailing Address - Country:US
Mailing Address - Phone:406-450-3492
Mailing Address - Fax:
Practice Address - Street 1:550 6TH AVE NORTH
Practice Address - Street 2:
Practice Address - City:WOLF POINT
Practice Address - State:MT
Practice Address - Zip Code:59201-0729
Practice Address - Country:US
Practice Address - Phone:406-653-3491
Practice Address - Fax:406-653-3728
Is Sole Proprietor?:No
Enumeration Date:2011-04-20
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT40077163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT2210068Medicaid