Healthcare Provider Details

I. General information

NPI: 1184893323
Provider Name (Legal Business Name): GAYLE L. STALEY RNCDE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2008
Last Update Date: 02/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2019 BROADWATER AVE
BILLINGS MT
59102-4810
US

IV. Provider business mailing address

2019 BROADWATER AVE
BILLINGS MT
59102-4810
US

V. Phone/Fax

Practice location:
  • Phone: 406-237-8500
  • Fax: 406-237-8501
Mailing address:
  • Phone: 406-237-8500
  • Fax: 406-237-8501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License NumberRN7749
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: