Provider Demographics
NPI:1750760815
Name:RICHMAN, TRACY L (RN, CNM)
Entity type:Individual
Prefix:MS
First Name:TRACY
Middle Name:L
Last Name:RICHMAN
Suffix:
Gender:F
Credentials:RN, CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 O'HAIRE BLVD
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:MT
Mailing Address - Zip Code:59474
Mailing Address - Country:US
Mailing Address - Phone:406-434-3100
Mailing Address - Fax:406-434-3143
Practice Address - Street 1:670 PARK AVE
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:MT
Practice Address - Zip Code:59474-1663
Practice Address - Country:US
Practice Address - Phone:406-434-3100
Practice Address - Fax:406-434-3143
Is Sole Proprietor?:No
Enumeration Date:2015-05-22
Last Update Date:2015-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT29023176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT29023OtherMONTANA LICENSE