Provider Demographics
NPI:1760008940
Name:FITZPATRICK, DENI MAYLIZ
Entity Type:Individual
Prefix:
First Name:DENI
Middle Name:MAYLIZ
Last Name:FITZPATRICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MONTANA STATE UNIVERSITY COLLEGE OF NURSING
Mailing Address - Street 2:ANNA PEARL SHERRICK HALL
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59717-3560
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:INDIAN FAMILY HEALTH CLINIC
Practice Address - Street 2:1220 CENTRAL AVENUE
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59401
Practice Address - Country:US
Practice Address - Phone:406-268-1510
Practice Address - Fax:406-268-1572
Is Sole Proprietor?:No
Enumeration Date:2020-06-23
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT177220363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health