Provider Demographics
NPI:1598838666
Name:IVERSEN, PATTI (APRNBC)
Entity Type:Individual
Prefix:
First Name:PATTI
Middle Name:
Last Name:IVERSEN
Suffix:
Gender:F
Credentials:APRNBC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 14TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:MT
Mailing Address - Zip Code:59270-3521
Mailing Address - Country:US
Mailing Address - Phone:406-488-2525
Mailing Address - Fax:406-488-2527
Practice Address - Street 1:214 14TH AVE SW
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:MT
Practice Address - Zip Code:59270-3521
Practice Address - Country:US
Practice Address - Phone:406-488-2525
Practice Address - Fax:406-488-2527
Is Sole Proprietor?:No
Enumeration Date:2006-11-16
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTRN10568363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND19787Medicaid
MT000374530OtherBLUE CROSS OF MT
MT4304842Medicaid
MTP91765Medicare UPIN
MT000084464Medicare ID - Type Unspecified
MT000374530OtherBLUE CROSS OF MT