Provider Demographics
NPI:1487520904
Name:BELCOURT, JENNA MARIE
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:MARIE
Last Name:BELCOURT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:915 RODGERS ST APT B
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802-1806
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:915 RODGERS ST APT B
Practice Address - Street 2:APT B
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-1806
Practice Address - Country:US
Practice Address - Phone:406-314-0847
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-13
Last Update Date:2025-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTNUR-LPN-LIC-76476164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse