Provider Demographics
NPI:1992178701
Name:HURD, DODI YVONNE (MT)
Entity Type:Individual
Prefix:
First Name:DODI
Middle Name:YVONNE
Last Name:HURD
Suffix:
Gender:F
Credentials:MT
Other - Prefix:
Other - First Name:DODI
Other - Middle Name:YVONNE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MT
Mailing Address - Street 1:4449 PINE COVE RD
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59106-1334
Mailing Address - Country:US
Mailing Address - Phone:406-690-8181
Mailing Address - Fax:
Practice Address - Street 1:4449 PINE COVE RD
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59106-1334
Practice Address - Country:US
Practice Address - Phone:406-690-8181
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-03
Last Update Date:2015-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTLMT-LMT-LIC-7903174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist