Provider Demographics
NPI:1538269766
Name:BERTANE, LYNN (NP)
Entity type:Individual
Prefix:
First Name:LYNN
Middle Name:
Last Name:BERTANE
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:PO BOX 16900
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59808
Mailing Address - Country:US
Mailing Address - Phone:406-327-4620
Mailing Address - Fax:406-549-5928
Practice Address - Street 1:2831 FORT MISSOULA RD
Practice Address - Street 2:PARKSIDE COMMUNITY FAMILY CARE
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59804
Practice Address - Country:US
Practice Address - Phone:406-327-3880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTRN10813363L00000X
MTAPRN100064363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT000370510OtherBCBS
MT1538269766Medicaid
MT000370510OtherBCBS
S51617Medicare UPIN