Healthcare Provider Details

I. General information

NPI: 1902076672
Provider Name (Legal Business Name): LAURIE B. GLOVER FNP, BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2008
Last Update Date: 03/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 15TH AVE S SUITE 106
GREAT FALLS MT
59405-4334
US

IV. Provider business mailing address

1318 16TH ST S
GREAT FALLS MT
59405-4713
US

V. Phone/Fax

Practice location:
  • Phone: 406-771-4443
  • Fax: 406-771-4449
Mailing address:
  • Phone: 406-761-1309
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberAPRN12606
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: