Provider Demographics
NPI:1255384251
Name:OLTZ, LARAYNE K (CRMA)
Entity type:Individual
Prefix:
First Name:LARAYNE
Middle Name:K
Last Name:OLTZ
Suffix:
Gender:F
Credentials:CRMA
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:K
Other - Last Name:OLTZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNA
Mailing Address - Street 1:202 CONWAY DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-3112
Mailing Address - Country:US
Mailing Address - Phone:406-751-5662
Mailing Address - Fax:406-755-0971
Practice Address - Street 1:310 SUNNYVIEW LN
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-3129
Practice Address - Country:US
Practice Address - Phone:406-751-7695
Practice Address - Fax:406-755-0971
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTRN7600367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT4308259Medicaid