Provider Demographics
NPI:1730771965
Name:PENCE, ERIN MARIE (CNM, RN)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:MARIE
Last Name:PENCE
Suffix:
Gender:F
Credentials:CNM, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2831 FORT MISSOULA RD STE 232
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59804-7479
Mailing Address - Country:US
Mailing Address - Phone:406-523-5650
Mailing Address - Fax:
Practice Address - Street 1:2831 FORT MISSOULA RD STE 232
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59804-7479
Practice Address - Country:US
Practice Address - Phone:406-523-5650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-09
Last Update Date:2021-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
367A00000X
MTNUR-RN-LIC-152526163WX0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163WX0003XNursing Service ProvidersRegistered NurseObstetric, Inpatient
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTNUR-RN-LIC-152526OtherMONTANA BOARD OF NURSING
MTNUR-APRN-LIC-174173OtherMONTANA BOARD OF NURSING