Provider Demographics
NPI:1770080137
Name:BLEVINS, MAGGI (RN)
Entity type:Individual
Prefix:
First Name:MAGGI
Middle Name:
Last Name:BLEVINS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:MAGGI
Other - Middle Name:
Other - Last Name:STIMSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1432
Mailing Address - Street 2:
Mailing Address - City:RED LODGE
Mailing Address - State:MT
Mailing Address - Zip Code:59068-1432
Mailing Address - Country:US
Mailing Address - Phone:406-426-0253
Mailing Address - Fax:406-446-0198
Practice Address - Street 1:215 N COOPER AVE
Practice Address - Street 2:
Practice Address - City:RED LODGE
Practice Address - State:MT
Practice Address - Zip Code:59068-9140
Practice Address - Country:US
Practice Address - Phone:406-426-0253
Practice Address - Fax:406-446-0198
Is Sole Proprietor?:No
Enumeration Date:2018-04-11
Last Update Date:2018-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTNUR-RN-LIC-22622163W00000X, 163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163W00000XNursing Service ProvidersRegistered Nurse