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NPI Code Detail

MEDICARE: MARNIE BASTA-SMITH

MEDICARE: MARNIE BASTA-SMITH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LP0808XPsychiatric/Mental Health Nurse PractitionerNUR-APRN-LIC-125902MT

General Provider Information

NPI Number : 1053849851
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARNIE BASTA-SMITH
Provider Business Mailing Address
First Line : 1695 TSCHACHE LN
Second Line :
City : BOZEMAN
State : MT
Zip : 59715-7965
Country : US
Telephone Number : 406-585-1360
Fax Number :
Provider Business Practice Location Address
First Line : 1695 TSCHACHE LN
Second Line :
City : BOZEMAN
State : MT
Zip : 59715-7965
Country : US
Telephone Number : 406-585-1360
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/24/2017
Last Update Date : 12/08/2025

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Directions to “ MARNIE BASTA-SMITH ” Practice Location

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