Individual
MRS. LIBBY A COSTELLO GARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP
Contact information
Practice address
1211 S RESERVE ST STE 101, MISSOULA, MT 59801-3103
(406) 327-3057
(406) 327-3231
Mailing address
500 W BROADWAY ST, MISSOULA, MT 59802-4008
(406) 327-1918
(406) 549-2246
Taxonomy
Speciality
Code
Description
License number
State
163WP2201X
Ambulatory Care Registered Nurse
099007632RN
OR
363LF0000X
Family Nurse Practitioner
200850014NP
OR
363LF0000X
Family Nurse Practitioner
Primary
NUR-APRN-LIC-126782
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500616442
—
OR
Enumeration date
08/07/2007
Last updated
05/10/2021
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