Healthcare Provider Details

I. General information

NPI: 1689199341
Provider Name (Legal Business Name): MELANY ROSTOCKI GARDNER DNP, PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/03/2017
Last Update Date: 08/16/2022
Certification Date: 08/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 HIGHLAND PARK BLVD
BOZEMAN MT
59715
US

IV. Provider business mailing address

915 HIGHLAND PARK BLVD
BOZEMAN MT
59715
US

V. Phone/Fax

Practice location:
  • Phone: 406-282-1625
  • Fax:
Mailing address:
  • Phone: 406-282-1625
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number71336
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number186530
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: