Healthcare Provider Details

I. General information

NPI: 1205044666
Provider Name (Legal Business Name): MARLYS MAGDALENE EGGUM FNPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 MAIN ST COURTHOUSE ANNEX
MILES CITY MT
59301-3419
US

IV. Provider business mailing address

208 3RD ST
GLENDIVE MT
59330-3512
US

V. Phone/Fax

Practice location:
  • Phone: 406-874-3377
  • Fax: 406-874-3459
Mailing address:
  • Phone: 406-365-4110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number21272
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: