Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LC0200X | Nurse Practitioner - Critical Care Medicine | MED-APRN-LIC-100379 | MT |
N | 363LF0000X | Nurse Practitioner - Family Medicine | 25494 | MT |
NPI | 1073820783 |
---|---|
Provider Name | Milissa Ann Priebe |
First Address | Bozeman, MT 59715-6902 |
Second Address | Bozeman, MT 59715-3219 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/09/2010 |
Last Update Date | 14/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1073820783 | (05) | MT |