Provider Demographics
NPI:1982842399
Name:CREEKMORE, CHARLOTTE CATHERINE (NP)
Entity Type:Individual
Prefix:
First Name:CHARLOTTE
Middle Name:CATHERINE
Last Name:CREEKMORE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:422 W SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802-4127
Mailing Address - Country:US
Mailing Address - Phone:406-546-6452
Mailing Address - Fax:
Practice Address - Street 1:422 W SPRUCE ST
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-4127
Practice Address - Country:US
Practice Address - Phone:406-219-8639
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-23
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT153063363LF0000X
MTLICENSENO37176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily