MEDICARE: LISA KINCANNON-ZIEGLER FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	100219	MT

General Provider Information

NPI Number	:	1366612327
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA KINCANNON-ZIEGLER FNP

Provider Business Mailing Address
First Line	:	700 ARLINGTON AVE
Second Line	:
City	:	MILES CITY
State	:	MT
Zip	:	59301-5605
Country	:	US
Telephone Number	:	406-480-4833
Fax Number	:

Provider Business Practice Location Address
First Line	:	700 ARLINGTON AVE
Second Line	:
City	:	MILES CITY
State	:	MT
Zip	:	59301-5605
Country	:	US
Telephone Number	:	406-480-4833
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/06/2008
Last Update Date	:	05/11/2017

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