Provider Demographics
NPI:1639382179
Name:MITCHELL, MARIE SILLS (PNP, FNP)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:SILLS
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:PNP, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7720 SHEDHORN DR STE D
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-8108
Mailing Address - Country:US
Mailing Address - Phone:406-556-8300
Mailing Address - Fax:406-556-8304
Practice Address - Street 1:7720 SHEDHORN DR STE D
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-8108
Practice Address - Country:US
Practice Address - Phone:406-556-8300
Practice Address - Fax:406-556-8304
Is Sole Proprietor?:No
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTRN20521363LF0000X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Not Answered363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT4307043Medicaid
Q12996Medicare UPIN