Healthcare Provider Details

I. General information

NPI: 1033298427
Provider Name (Legal Business Name): SANDY APPLEBY FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2411 W MAIN ST STE 1A
BOZEMAN MT
59718-3815
US

IV. Provider business mailing address

2411 W MAIN ST STE 1A
BOZEMAN MT
59718-3815
US

V. Phone/Fax

Practice location:
  • Phone: 406-587-2652
  • Fax:
Mailing address:
  • Phone: 406-587-2652
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN24208
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: