Healthcare Provider Details

I. General information

NPI: 1073820783
Provider Name (Legal Business Name): MILISSA ANN PRIEBE NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2010
Last Update Date: 04/09/2025
Certification Date: 04/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1006 W MAIN ST
BOZEMAN MT
59715-3219
US

IV. Provider business mailing address

915 HIGHLAND BLVD ATTN PFS CREDENTIALING
BOZEMAN MT
59715-6902
US

V. Phone/Fax

Practice location:
  • Phone: 406-414-4800
  • Fax:
Mailing address:
  • Phone: 406-414-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number25494
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License NumberMED-APRN-LIC-100379
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: