Healthcare Provider Details

I. General information

NPI: 1871504589
Provider Name (Legal Business Name): BERNADETTE A GLASSER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 02/01/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 EASTSIDE HWY
STEVENSVILLE MT
59870-2224
US

IV. Provider business mailing address

3800 EASTSIDE HWY
STEVENSVILLE MT
59870-2224
US

V. Phone/Fax

Practice location:
  • Phone: 406-777-2775
  • Fax: 406-777-2796
Mailing address:
  • Phone: 406-777-2775
  • Fax: 406-777-2796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN11736
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number105874
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: