Healthcare Provider Details

I. General information

NPI: 1275634891
Provider Name (Legal Business Name): DONNA GAYLE PORTE APRN-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 01/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 BROADWAY SUITE 200
HELENA MT
59604
US

IV. Provider business mailing address

10573 HORSEBACK RIDGE RD
MISSOULA MT
59804-5800
US

V. Phone/Fax

Practice location:
  • Phone: 406-457-4343
  • Fax: 406-457-4344
Mailing address:
  • Phone: 406-594-0955
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNUR-APRN-LIC-100271
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberRN19923
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: