Provider Demographics
NPI:1134420318
Name:FERESTAD, DEANNA MARIE (NP-C)
Entity type:Individual
Prefix:
First Name:DEANNA
Middle Name:MARIE
Last Name:FERESTAD
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 N FOUR BUTTES RD
Mailing Address - Street 2:
Mailing Address - City:SCOBEY
Mailing Address - State:MT
Mailing Address - Zip Code:59263-9522
Mailing Address - Country:US
Mailing Address - Phone:406-783-5224
Mailing Address - Fax:
Practice Address - Street 1:105 5TH AVE E
Practice Address - Street 2:
Practice Address - City:SCOBEY
Practice Address - State:MT
Practice Address - Zip Code:59263-0400
Practice Address - Country:US
Practice Address - Phone:406-487-2296
Practice Address - Fax:406-487-2680
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-04
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT23686363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner