Healthcare Provider Details

I. General information

NPI: 1437728037
Provider Name (Legal Business Name): NICOLE MARIE FAESSEL APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NICOLE MARIE DAVIS PMHNP-BC, PMH-C

II. Dates (important events)

Enumeration Date: 06/18/2021
Last Update Date: 04/24/2025
Certification Date: 04/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 CHASE WAY APT B
BOZEMAN MT
59718-5473
US

IV. Provider business mailing address

355 CHASE WAY APT B
BOZEMAN MT
59718-5473
US

V. Phone/Fax

Practice location:
  • Phone: 406-201-5937
  • Fax: 888-829-4791
Mailing address:
  • Phone: 406-201-5937
  • Fax: 888-829-4791

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number70357
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number267058
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberTPAN1125
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberNUR-APRN-LIC-176359
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: