Provider Demographics
NPI:1083921233
Name:BASKETT, SALLY REBECCA (APRN)
Entity Type:Individual
Prefix:
First Name:SALLY
Middle Name:REBECCA
Last Name:BASKETT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:154 REVAIS CREEK RD
Mailing Address - Street 2:
Mailing Address - City:DIXON
Mailing Address - State:MT
Mailing Address - Zip Code:59831-9519
Mailing Address - Country:US
Mailing Address - Phone:406-246-0035
Mailing Address - Fax:
Practice Address - Street 1:702 SW HIGGINS AVE
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59803-1429
Practice Address - Country:US
Practice Address - Phone:406-721-9543
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-09
Last Update Date:2010-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT18203363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily