Healthcare Provider Details

I. General information

NPI: 1376864546
Provider Name (Legal Business Name): ROSELYNN A. GENTLES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2010
Last Update Date: 11/07/2022
Certification Date: 11/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

817 COMMERCIAL ST
LEAVENWORTH WA
98826-1316
US

IV. Provider business mailing address

400 S CLARK ST
BUTTE MT
59701-2328
US

V. Phone/Fax

Practice location:
  • Phone: 509-548-5815
  • Fax: 509-548-2510
Mailing address:
  • Phone: 406-723-2500
  • Fax: 406-723-2483

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number4270
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number25490
License Number StateMT
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD60632019
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: