Provider Demographics
NPI:1881691400
Name:GILMAN, JUDY A (NP)
Entity type:Individual
Prefix:
First Name:JUDY
Middle Name:A
Last Name:GILMAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:805 HOWARD ST
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59804-1903
Mailing Address - Country:US
Mailing Address - Phone:406-546-7819
Mailing Address - Fax:406-728-4919
Practice Address - Street 1:805 HOWARD ST
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59804-1903
Practice Address - Country:US
Practice Address - Phone:406-546-7819
Practice Address - Fax:406-728-4919
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-29
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTRN7426363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MTMG0047109OtherDEA
MTMG0047109OtherDEA