Provider Demographics
NPI:1073231023
Name:MANHART, GINA KAY
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:KAY
Last Name:MANHART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 S 4TH ST W
Mailing Address - Street 2:
Mailing Address - City:BAKER
Mailing Address - State:MT
Mailing Address - Zip Code:59313-9156
Mailing Address - Country:US
Mailing Address - Phone:406-778-2833
Mailing Address - Fax:
Practice Address - Street 1:202 S 4TH ST W
Practice Address - Street 2:
Practice Address - City:BAKER
Practice Address - State:MT
Practice Address - Zip Code:59313-9156
Practice Address - Country:US
Practice Address - Phone:406-778-2833
Practice Address - Fax:406-778-5355
Is Sole Proprietor?:No
Enumeration Date:2022-08-16
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4792138900363L00000X
MTNUR-APRN-LIC-195947363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner