Provider Demographics
NPI:1902230956
Name:MISTRETTA, KATHERINE DIANE (DNP)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:DIANE
Last Name:MISTRETTA
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:439 N BLACK AVE
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-3611
Mailing Address - Country:US
Mailing Address - Phone:406-599-3707
Mailing Address - Fax:
Practice Address - Street 1:316 E BABCOCK ST
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-4710
Practice Address - Country:US
Practice Address - Phone:406-585-0022
Practice Address - Fax:406-585-0032
Is Sole Proprietor?:No
Enumeration Date:2013-08-27
Last Update Date:2022-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT2013002702363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily