Provider Demographics
NPI:1275634891
Name:PORTE, DONNA GAYLE (APRN-BC)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:GAYLE
Last Name:PORTE
Suffix:
Gender:F
Credentials:APRN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10573 HORSEBACK RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59804-5800
Mailing Address - Country:US
Mailing Address - Phone:406-594-0955
Mailing Address - Fax:
Practice Address - Street 1:2525 BROADWAY
Practice Address - Street 2:SUITE 200
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59604
Practice Address - Country:US
Practice Address - Phone:406-457-4343
Practice Address - Fax:406-457-4344
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2018-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTRN19923207RG0100X
MTNUR-APRN-LIC-100271363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT4306372Medicaid
MT370001OtherBCBS OF MT
MT4306372Medicaid
MTS96456Medicare UPIN