Healthcare Provider Details

I. General information

NPI: 1659359792
Provider Name (Legal Business Name): DAWN GORMELY FNPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2006
Last Update Date: 02/25/2020
Certification Date: 02/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1930 9TH AVENUE
HELENA MT
59601
US

IV. Provider business mailing address

1930 9TH AVE
HELENA MT
59601-4759
US

V. Phone/Fax

Practice location:
  • Phone: 406-457-0000
  • Fax: 406-457-8992
Mailing address:
  • Phone: 406-457-0000
  • Fax: 406-500-2128

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberMTRN016908
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: