Provider Demographics
NPI:1093412249
Name:PEHLER, GWYNN MARIE (FNP-BC)
Entity Type:Individual
Prefix:
First Name:GWYNN
Middle Name:MARIE
Last Name:PEHLER
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1732 AVENUE C
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59102-2922
Mailing Address - Country:US
Mailing Address - Phone:406-861-0657
Mailing Address - Fax:
Practice Address - Street 1:2223 MISSION WAY
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59102-0160
Practice Address - Country:US
Practice Address - Phone:406-237-8282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-08
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT2022026626363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily