Provider Demographics
NPI:1659359792
Name:GORMELY, DAWN (FNPC)
Entity Type:Individual
Prefix:MS
First Name:DAWN
Middle Name:
Last Name:GORMELY
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 1:1930 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-4759
Mailing Address - Country:US
Mailing Address - Phone:406-457-0000
Mailing Address - Fax:406-500-2128
Practice Address - Street 1:1930 9TH AVENUE
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601
Practice Address - Country:US
Practice Address - Phone:406-457-0000
Practice Address - Fax:406-457-8992
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTMTRN016908363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT50006414OtherRAILROAD MEDICARE
MT37086OtherBCBS
MT439036Medicaid
MT50006414OtherRAILROAD MEDICARE
MT37086OtherBCBS