Provider Demographics
NPI:1619054814
Name:LYMAN, GERALDINE BRENDA (CRNA)
Entity Type:Individual
Prefix:MS
First Name:GERALDINE
Middle Name:BRENDA
Last Name:LYMAN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 3925
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59722-3925
Mailing Address - Country:US
Mailing Address - Phone:406-585-9662
Mailing Address - Fax:
Practice Address - Street 1:300 N WILLSON AVE
Practice Address - Street 2:SAME DAY SURGERY CENTER
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-3551
Practice Address - Country:US
Practice Address - Phone:406-585-9662
Practice Address - Fax:406-587-7656
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTRN9328367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT000091095 BCOtherCRNA
MT0439433Medicaid
MT0439433Medicaid