Basic Information
| Provider Information | |||||||||
| NPI: | 1790290096 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | YONCHEK | ||||||||
| FirstName: | LEEANNE | ||||||||
| MiddleName: | MICHELLE | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | PA-C | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | STOREY | ||||||||
| OtherFirstName: | LEEANNE | ||||||||
| OtherMiddleName: | MICHELE | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | PA-C | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 6369 | ||||||||
| Address2: | |||||||||
| City: | HELENA | ||||||||
| State: | MT | ||||||||
| PostalCode: | 596046369 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4064472823 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2550 E BROADWAY ST | ||||||||
| Address2: | |||||||||
| City: | HELENA | ||||||||
| State: | MT | ||||||||
| PostalCode: | 596014905 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4064574180 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/08/2017 | ||||||||
| LastUpdateDate: | 05/29/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 05/29/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | MED-PAC-LIC-60753 | MT | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 207Q00000X | MED-PAC-LIC-60753 | MT | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.