Suzanne C Gullotta, APRN

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

020838 Issued in MT

Practice address

77 Deer Creek Rd
Somers, MT 59932

Phone

(406) 857-2997

Fax

(406) 857-2996

NPI assigned

Jul 18, 2005

Reactivated

Aug 15, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Lakeside Clinic P.C.

  • Primary Care Clinic/Center
  • Somers, MT
  • NPI 1053665091
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1121644800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1962401372",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 649",
            "city": "LAKESIDE",
            "state": "MT",
            "postal_code": "599220649",
            "telephone_number": "406-857-2997",
            "fax_number": "406-587-2996"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "77 DEER CREEK RD",
            "city": "SOMERS",
            "state": "MT",
            "postal_code": "59932",
            "telephone_number": "406-857-2997",
            "fax_number": "406-857-2996"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GULLOTTA",
        "first_name": "SUZANNE",
        "middle_name": "C",
        "name_prefix": "Mrs.",
        "credential": "APRN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-07-18",
        "last_updated": "2007-07-09",
        "deactivation_date": "2006-03-18",
        "reactivation_date": "2006-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MT",
            "license": "020838",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MONTANA BCBS NUMBER",
            "identifier": "0037108",
            "state": "MT"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0434707",
            "state": "MT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• County of Flathead School District 29
• Denise Lynn Davies
• Evoke Changes LLC
• Valerie A Goss, NBC-HWC
• Lakeside Clinic P.C.
• Lakeside Wellness PC
• Myia L Powers, L.C.S.W.
• Suzanne C Gullotta
• Ariane Nicole Waller, LCSW

• Family Nurse Practitioner in Somers, MT
• Providers in Somers, MT by specialty
• Family Nurse Practitioner in Montana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.