Provider Demographics
NPI:1750383287
Name:GRESHAM, DENISE G (FNP)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:G
Last Name:GRESHAM
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:DENISE
Other - Middle Name:G
Other - Last Name:STIMAC
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP
Mailing Address - Street 1:2517 7TH AVE S
Mailing Address - Street 2:STE B3
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405-3033
Mailing Address - Country:US
Mailing Address - Phone:406-315-3503
Mailing Address - Fax:406-315-3505
Practice Address - Street 1:2517 7TH AVE S
Practice Address - Street 2:B-3
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-3032
Practice Address - Country:US
Practice Address - Phone:406-315-3503
Practice Address - Fax:406-315-3505
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-15
Last Update Date:2016-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTRN019237363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0434148Medicaid
MT0434148Medicaid