Provider Demographics
NPI:1992114896
Name:ROBERTSON, BRITTANY MAILLET (PA-C, MMSC)
Entity type:Individual
Prefix:
First Name:BRITTANY
Middle Name:MAILLET
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:PA-C, MMSC
Other - Prefix:
Other - First Name:BRITTANY
Other - Middle Name:ANN
Other - Last Name:MAILLET
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:500 W BROADWAY ST FL 5
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802-4096
Mailing Address - Country:US
Mailing Address - Phone:406-329-2736
Mailing Address - Fax:
Practice Address - Street 1:500 W BROADWAY ST FL 5
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-4096
Practice Address - Country:US
Practice Address - Phone:406-329-2736
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-05
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT77041363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant