Provider Demographics
NPI:1174789499
Name:CONROY, REBECCA J (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:J
Last Name:CONROY
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 WESTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:MT
Mailing Address - Zip Code:59840-2345
Mailing Address - Country:US
Mailing Address - Phone:406-363-2211
Mailing Address - Fax:406-549-5928
Practice Address - Street 1:2386 US HIGHWAY 93 N
Practice Address - Street 2:
Practice Address - City:VICTOR
Practice Address - State:MT
Practice Address - Zip Code:59875-9211
Practice Address - Country:US
Practice Address - Phone:406-375-2990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-06
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT38236363LF0000X
IDNP-875A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1174789499Medicaid
MT1174789499Medicaid