Provider Demographics
NPI:1649365271
Name:LINDSAY, BLYTHE (PAC)
Entity type:Individual
Prefix:
First Name:BLYTHE
Middle Name:
Last Name:LINDSAY
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:BLYTHE
Other - Middle Name:LINDSAY
Other - Last Name:NIRGENAU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:1648 ELLIS STREET
Mailing Address - Street 2:SUITE 301
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-8811
Mailing Address - Country:US
Mailing Address - Phone:406-556-9798
Mailing Address - Fax:406-556-9795
Practice Address - Street 1:1648 ELLIS STREET
Practice Address - Street 2:SUITE 301
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-8811
Practice Address - Country:US
Practice Address - Phone:406-556-9798
Practice Address - Fax:406-556-9798
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT419363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT419OtherSTATE LICENSE
MT0183833Medicaid
MT0183833Medicaid
MT419OtherSTATE LICENSE