Provider Demographics
NPI:1043550510
Name:NIGHTGUN, STARLITE Y (RN)
Entity Type:Individual
Prefix:
First Name:STARLITE
Middle Name:Y
Last Name:NIGHTGUN
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:STARLITE
Other - Middle Name:Y
Other - Last Name:BREWER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:P.O. BOX 880
Mailing Address - Street 2:
Mailing Address - City:ST. IGNATIUS
Mailing Address - State:MT
Mailing Address - Zip Code:59865
Mailing Address - Country:US
Mailing Address - Phone:406-745-3525
Mailing Address - Fax:406-745-3529
Practice Address - Street 1:308 MISSION DRIVE
Practice Address - Street 2:
Practice Address - City:ST. IGNATIUS
Practice Address - State:MT
Practice Address - Zip Code:59865
Practice Address - Country:US
Practice Address - Phone:406-745-3525
Practice Address - Fax:406-745-3529
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-21
Last Update Date:2013-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT45507163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse