Provider Demographics
NPI:1740396142
Name:GRENA, PATRICIA J (DO)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:J
Last Name:GRENA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 S MAIN ST STE 7
Mailing Address - Street 2:
Mailing Address - City:CONRAD
Mailing Address - State:MT
Mailing Address - Zip Code:59425-2532
Mailing Address - Country:US
Mailing Address - Phone:406-271-2305
Mailing Address - Fax:406-271-2669
Practice Address - Street 1:600 S MAIN ST STE 7
Practice Address - Street 2:
Practice Address - City:CONRAD
Practice Address - State:MT
Practice Address - Zip Code:59425-2532
Practice Address - Country:US
Practice Address - Phone:406-271-2305
Practice Address - Fax:406-271-2669
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2018-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT8120207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0083776Medicaid
MTF22566Medicare UPIN