Healthcare Provider Details

I. General information

NPI: 1760396519
Provider Name (Legal Business Name): AEVUM FUNCTIONAL MEDICINE & LONGEVITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2047 BROADWATER AVE STE 3
BILLINGS MT
59102-4856
US

IV. Provider business mailing address

2047 BROADWATER AVE STE 3
BILLINGS MT
59102-4856
US

V. Phone/Fax

Practice location:
  • Phone: 406-617-6120
  • Fax:
Mailing address:
  • Phone: 406-617-6120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateNULL

VIII. Authorized Official

Name: TAYLOR HATCHER GREGORY
Title or Position: OWNER, NURSE PRACTITIONER
Credential: AGAC-NP
Phone: 406-617-6120