Provider Demographics
NPI:1982902367
Name:DUMOUCHEL, MICHAEL LUCIAN (DNP, CRNA, NSPM-C)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:LUCIAN
Last Name:DUMOUCHEL
Suffix:
Gender:M
Credentials:DNP, CRNA, NSPM-C
Other - Prefix:
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Mailing Address - Street 1:877 BAYVIEW DR
Mailing Address - Street 2:
Mailing Address - City:POLSON
Mailing Address - State:MT
Mailing Address - Zip Code:59860-9680
Mailing Address - Country:US
Mailing Address - Phone:760-415-3809
Mailing Address - Fax:
Practice Address - Street 1:6 13TH AVE E
Practice Address - Street 2:
Practice Address - City:POLSON
Practice Address - State:MT
Practice Address - Zip Code:59860-5315
Practice Address - Country:US
Practice Address - Phone:406-883-8924
Practice Address - Fax:406-883-8405
Is Sole Proprietor?:No
Enumeration Date:2011-03-08
Last Update Date:2025-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTNUR-APRN-LIC-165777208VP0014X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine