Provider Demographics
NPI:1447347281
Name:PESSL, LIESE (NPF)
Entity type:Individual
Prefix:
First Name:LIESE
Middle Name:
Last Name:PESSL
Suffix:
Gender:F
Credentials:NPF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 S MAIN ST
Mailing Address - Street 2:COMMUNITY HEALTH PARTNERS
Mailing Address - City:LIVINGSTON
Mailing Address - State:MT
Mailing Address - Zip Code:59047-2624
Mailing Address - Country:US
Mailing Address - Phone:406-222-1111
Mailing Address - Fax:406-823-6305
Practice Address - Street 1:214 E MENDENHALL ST
Practice Address - Street 2:GALLATIN COMMUNITY CLINIC
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-3638
Practice Address - Country:US
Practice Address - Phone:406-525-1360
Practice Address - Fax:406-823-6305
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2012-01-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MTRN22756363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT307502Medicaid