Provider Demographics
NPI:1205044666
Name:EGGUM, MARLYS MAGDALENE (FNPC)
Entity Type:Individual
Prefix:
First Name:MARLYS
Middle Name:MAGDALENE
Last Name:EGGUM
Suffix:
Gender:F
Credentials:FNPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:208 3RD ST
Mailing Address - Street 2:
Mailing Address - City:GLENDIVE
Mailing Address - State:MT
Mailing Address - Zip Code:59330-3512
Mailing Address - Country:US
Mailing Address - Phone:406-365-4110
Mailing Address - Fax:
Practice Address - Street 1:1010 MAIN ST
Practice Address - Street 2:COURTHOUSE ANNEX
Practice Address - City:MILES CITY
Practice Address - State:MT
Practice Address - Zip Code:59301-3419
Practice Address - Country:US
Practice Address - Phone:406-874-3377
Practice Address - Fax:406-874-3459
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT21272363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily