MEDICARE: KILLEEN BERGER NIELSEN 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	100113	MT

General Provider Information

NPI Number	:	1962513119
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KILLEEN BERGER NIELSEN FNP

Provider Business Mailing Address
First Line	:	900 N ORANGE ST STE 203
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59802-2951
Country	:	US
Telephone Number	:	406-329-2954
Fax Number	:	406-327-3100

Provider Business Practice Location Address
First Line	:	900 N ORANGE ST STE 203
Second Line	:
City	:	MISSOULA
State	:	MT
Zip	:	59802-2951
Country	:	US
Telephone Number	:	406-329-2954
Fax Number	:	406-327-3100

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	03/22/2018

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