Healthcare Provider Details

I. General information

NPI: 1487829180
Provider Name (Legal Business Name): WENDY COURTNAGE TILLEMAN APRN, FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2008
Last Update Date: 10/08/2021
Certification Date: 09/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6850 UPPER OX ELDER ROAD
BOX ELDER MT
59521-9797
US

IV. Provider business mailing address

6850 UPPER BOX ELDER RD
BOX ELDER MT
59521-9073
US

V. Phone/Fax

Practice location:
  • Phone: 406-395-4486
  • Fax: 406-395-5850
Mailing address:
  • Phone: 406-395-4486
  • Fax: 406-395-5850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN25483
License Number StateMT
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNUR-APRN-LIC-177081
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: