Organization
SUZANNE C GULLOTTA
Active
Other names
Lakeside Family Health Center
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. SUZANNE C GULLOTTA NP (OWNER)
(406) 857-2997
Entity
Organization
Contact information
Practice address
77 DEER CREEK ROAD, SOMERS, MT 59932
(406) 857-2997
Mailing address
PO BOX 649, LAKESIDE, MT 59922-0649
(406) 857-2997
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
020838
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
037108
BCBS
MT
05
—
0434707
—
MT
Enumeration date
09/20/2006
Last updated
01/18/2008
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