Active NPI
Raeanne Wall
- Registered Nurse
- Box Elder, MT
National Provider Identifier
1972993152
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- RN 26269
- Practice address
- 535 Clinic Rd E
Box Elder, MT 59521-8826 - Phone
- (406) 395-4486
- Fax
- (406) 395-4138
- NPI assigned
- Jan 27, 2015
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | RN 26269 | MT | Primary |
Addresses
Primary practice location
535 Clinic Rd E
Box Elder, MT 59521-8826
Mailing address
535 Clinic Rd E
Box Elder, MT 59521-8826
Phone (406) 395-4486
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN 26269 | MT | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1422316800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1422316800000",
"number": "1972993152",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "535 CLINIC RD E",
"city": "BOX ELDER",
"state": "MT",
"postal_code": "595218826",
"telephone_number": "406-395-4486",
"fax_number": "406-395-4138"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "535 CLINIC RD E",
"city": "BOX ELDER",
"state": "MT",
"postal_code": "595218826",
"telephone_number": "406-395-4486",
"fax_number": "406-395-4138"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALL",
"first_name": "RAEANNE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-01-27",
"last_updated": "2015-01-27",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "MT",
"license": "RN 26269",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Box Elder, MT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.