Provider Demographics
NPI:1003530668
Name:ELLENS, REBECCA FAITH (DNP, APRN, CPNP-PC)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:FAITH
Last Name:ELLENS
Suffix:
Gender:F
Credentials:DNP, APRN, CPNP-PC
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:FAITH
Other - Last Name:SANDSTROM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:280 W KAGY BLVD STE G
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-6056
Mailing Address - Country:US
Mailing Address - Phone:406-587-5870
Mailing Address - Fax:406-522-1536
Practice Address - Street 1:280 W KAGY BLVD STE G
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-6056
Practice Address - Country:US
Practice Address - Phone:406-587-5870
Practice Address - Fax:406-522-1536
Is Sole Proprietor?:No
Enumeration Date:2022-09-28
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTNUR-APRN-LIC-198093363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics