Healthcare Provider Details

I. General information

NPI: 1255111530
Provider Name (Legal Business Name): BAILEY MARIE GLEASON FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2023
Last Update Date: 10/03/2023
Certification Date: 10/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

435 S CRYSTAL ST STE 400
BUTTE MT
59701-1599
US

IV. Provider business mailing address

1226 W GOLD ST
BUTTE MT
59701-2110
US

V. Phone/Fax

Practice location:
  • Phone: 406-496-3400
  • Fax:
Mailing address:
  • Phone: 406-498-5645
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNUR-APRN-LIC-219554
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: